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Restrictive left ventricular diastolic filling identifies patients with heart failure after acute myocardial
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Insights
Diastolic filling patterns assessed by Doppler echocardiography can identify heart failure after myocardial infarction. Shorter deceleration time is a key predictor of left ventricular failure post-MI.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Background:
- Left ventricular diastolic dysfunction is a significant complication following acute myocardial infarction (AMI).
- Clinical heart failure assessment post-MI often relies on systolic function, potentially overlooking diastolic impairments.
Purpose of the Study:
- To investigate the utility of transmitral pulsed-wave Doppler (PWD) velocities in characterizing left ventricular diastolic filling in AMI patients.
- To correlate diastolic filling variables with the presence and severity of clinical heart failure post-MI.
Main Methods:
- Transmitral PWD velocities were analyzed in 62 patients with AMI.
- Patients were categorized based on the presence of clinical heart failure (Killip class II-IV vs. no heart failure).
- Diastolic filling variables, including peak early (E) and late (A) filling wave velocities and deceleration time, were compared between groups.
Main Results:
- Patients with heart failure exhibited a lower peak A velocity (0.48 vs. 0.59 m/sec) and a shorter deceleration time (136 vs. 196 msec) compared to those without heart failure.
- The E/A ratio was higher in patients with heart failure (1.5 vs. 1.1).
- Multivariate analysis identified deceleration time as an independent predictor of heart failure, even after accounting for systolic function.
Conclusions:
- Transmitral PWD-derived diastolic filling variables, particularly deceleration time, are valuable in identifying left ventricular failure post-MI.
- Diastolic filling parameters can complement systolic function assessments for improved diagnosis of postinfarction heart failure.
Abstract:
Left ventricular diastolic filling was characterized by transmitral pulsed-wave Doppler velocities in 62 patients with acute myocardial infarction, and diastolic filling variables were correlated with the presence of clinical heart failure. At the time of admission, 47 patients were free of heart failure and 15 patients were in Killip class II to IV. In the latter group of patients with heart failure, peak velocity of late filling wave caused by atrial contraction (A) was lower (0.48 versus 0.59 m/sec, p < 0.05), ratio of peak velocity of early rapid filling wave to peak velocity of late filling wave caused by atrial contraction (E/A) was higher (1.5 versus 1.1, p < 0.01), and deceleration time (136 versus 196 msec, p = 0.0001) was shorter when compared with the patients not in heart failure after acute myocardial infarction. Multivariate analysis showed that the deceleration time was a powerful independent predictor of presence of heart failure after controlling for systolic functional variables. Therefore, diastolic filling variables can complement systolic functional variables in the identification of the patients with postinfarction left ventricular failure.