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[Prognostic value of a model using restricted left ventricular filling for prediction of developing heart failure
Barbara Brzeznińska1, Krystyna Łoboz-Grudzień, Alicja Kowalska
1Oddział Kardiologiczny Dolnoślaskiego Szpitala Specjalistycznego im. T. Marciniaka, 42-420 Wrocław, ul. Traugutta 116. Barbara.1656177@pharmanet.com.pl
Unlabelled:
The prognostic significance of restrictive pattern (RP) of mitral flow in myocardial infarction (MI) has yet not been defined. The aim of the study was to assess the relationship of a RP in MI patients at discharge with the development of left ventricular (LV) dilatation and clinical symptoms of heart failure (HF) after one year.
Methods:
2D and Doppler Echocardiography was performed on 88 patients (mean age 53.8 +/- 11) at discharge after their first MI and then one year after that MI. Patients were classified according to Doppler examination at discharge into 2 groups: Group I-RP (n = 9) with peak E to A ratio E/A > or = 2 or E/A > or = 1.5 and deceleration time DT < or = 140 ms, Group II--non-restrictive pattern nRP (n = 79). In predicting the development of HF the following variables were analysed using Cox proportional hazard model: MI location and extension (Inf, Ant, non-Q, Q-wave), reperfusion defined by non-invasive features (R/+/, R/-/), Killip-Kimball class (K-K), end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), wall motion score index (WMSI) and restrictive pattern of mitral flow presence (RP).
Results:
HF developed in 23 patients: 8 pts were in RP-group (89%), while 15 pts were in nRP-group (19%) (rr = 4.68 p < or = 0.001). In the univariate Cox analysis, the following variables were associated with higher incidence of HF: Q-MI (rr = 5.66 p < or = 0.05), R- (rr = 4.96 p < or = 0.001), K-K > or = II (rr = 3.13 p < or = 0.01), EDVI > or = 80 ml/m2 (rr = 5.85 p < or = 0.001), ESVI > or = 40 ml/m2 (rr = 4.07 p < or = 0.001), WMSI > or = 1.4 (rr = 2.79 p < or = 0.01) and RP (rr = 4.6 p < or = 0.001). However, the multivariate Cox analysis revealed only three significant independent predictors of HF: EDVI > or = 80 ml/m2 (rr = 6.27 p < or = 0.001), R- (rr = 4.74 p < or = 0.01) and RP (rr = 3.2 p < or = 0.05). The cumulative predictive power of RP in connection with the selected parameters (RP + K-K > or = II, RP + EF < or = 45%, RP + WMSI > or = 1.4) was higher for RP + K-K > or = II (rr = 4.61 p < or = 0.001) and especially for RP + WMSI > or = 1.4 (rr = 5.06 p < or = 0.001).
Conclusion:
The restrictive pattern of LV filling in MI pts at discharge is an independent predictor of heart failure development. The assessment of both diastolic and systolic LV functions parameters increases prediction power.
Insights
The restrictive pattern of mitral flow in myocardial infarction (MI) patients is an independent predictor of heart failure development. Assessing diastolic and systolic left ventricular (LV) function improves prediction power for heart failure after MI.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- The prognostic significance of restrictive pattern (RP) of mitral flow in myocardial infarction (MI) is not well-defined.
- Early identification of patients at risk for heart failure (HF) post-MI is crucial for timely intervention.
Purpose of the Study:
- To assess the relationship between restrictive pattern (RP) of mitral flow at discharge and the development of left ventricular (LV) dilatation and heart failure (HF) symptoms one year after MI.
- To determine if RP is an independent predictor of HF development in MI patients.
Main Methods:
- 88 patients with first MI underwent 2D and Doppler Echocardiography at discharge and one year post-MI.
- Patients were classified into restrictive pattern (RP) and non-restrictive pattern (nRP) groups based on Doppler findings.
- Cox proportional hazard models were used to analyze predictors of HF, including MI characteristics, reperfusion status, Killip-Kimball class, LV volumes, ejection fraction, and RP.
Main Results:
- Heart failure developed in 89% of RP patients versus 19% of nRP patients (rate ratio [rr] = 4.68, p < 0.001).
- Multivariate analysis identified end-diastolic volume index (EDVI) ≥ 80 ml/m², R- reperfusion, and RP as independent predictors of HF.
- Combining RP with Killip-Kimball class or wall motion score index significantly increased predictive power for HF.
Conclusions:
- Restrictive pattern of LV filling in MI patients at discharge is an independent predictor of heart failure development.
- Assessing both diastolic (RP) and systolic LV function parameters enhances the prediction power for HF post-MI.