Is left ventricular diastolic function an independent marker of prognosis after acute myocardial infarction?
Miguel Quintana1, Magnus Edner, Thomas Kahan
1Department of Cardiology, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden. miguel.quintana@labmed.ki.se
Insights
Clinical risk factors and left ventricular (LV) systolic function are key predictors of outcomes after myocardial infarction (MI). LV diastolic function, assessed by Doppler echocardiography, did not add prognostic value in this large patient cohort.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Medicine
Background:
- Left ventricular (LV) systolic function is a known prognostic marker post-myocardial infarction (MI).
- Previous research suggested LV diastolic function may also offer prognostic insights.
- This study investigated LV diastolic function's prognostic role in acute MI patients receiving thrombolytic therapy.
Purpose of the Study:
- To determine if LV diastolic function provides additional prognostic information beyond clinical risk markers and LV systolic function in acute MI patients.
- To assess the predictive value of LV diastolic function for cardiovascular death and combined end-points after MI.
Main Methods:
- Utilized data from 520 patients with ST-elevation MI from the ATTACC study.
- Performed two-dimensional and Doppler echocardiography 4-10 days post-admission.
- Followed patients for a median of 31 months for cardiovascular death and nonfatal MI.
Main Results:
- LV systolic function indices and clinical factors (hypertension, diabetes, prior MI) were independent predictors of cardiovascular death and combined end-points.
- A restrictive filling pattern was the only diastolic parameter predicting cardiovascular death in univariate analysis.
- LV diastolic function did not provide additional prognostic information in multivariate analysis.
Conclusions:
- Clinical risk indicators and LV systolic function are the primary independent predictors of adverse cardiovascular outcomes post-MI.
- Doppler-echocardiography assessment of LV diastolic function does not enhance prognostic stratification in this patient population.
Background:
In addition to clinical risk markers, indices of left ventricular (LV) systolic function are valuable prognostic markers after acute myocardial infarction (MI). Previous studies have also suggested that LV diastolic function may contribute with prognostic information. The present study assessed whether this assumption applies to a large population of patients with acute MI who underwent thrombolytic therapy.
Methods And Results:
520 out of 608 patients participating in the ATTenuation by Adenosine of Cardiac Complications (ATTACC) study, with an ST-elevation acute MI underwent two-dimensional and Doppler echocardiographic examination at 4 (range 2-10) days after admission. During the follow-up period of 31 (S.D. +/- 11) months, cardiovascular death occurred in 57 (11%) patients, nonfatal acute MI occurred in 77 (15%), and 124 (24%) patients suffered a combined cardiovascular end-point (either nonfatal acute MI or cardiovascular death). Univariate regression analysis showed that all indices of LV systolic function predicted cardiovascular death and combined cardiovascular end-points. Regarding LV diastolic function only a restrictive filling pattern predicted cardiovascular death. In a multistep multivariate regression analysis in which the variables were introduced in a hierarchic order age, history of systemic hypertension, wall motion score index (WMSi), and history of previous MI and diabetes mellitus were independent predictors of cardiovascular death. A history of systemic hypertension or congestive heart failure were independent predictors of nonfatal acute MI, while a history of systemic hypertension, wall motion score index and diabetes mellitus independently predicted combined cardiovascular end-points.
Conclusions:
The results of this study confirmed that clinical risk indicators and LV systolic function were the most important independent predictors of cardiovascular death and combined cardiovascular end-points. LV diastolic function assessed by Doppler-echocardiography did not provide additional prognostic information.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:22Mitral Stenosis I: Introduction
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:20Mitral Regurgitation I: Introduction
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies