Serial Doppler echocardiographic assessment of diastolic dysfunction during acute myocardial infarction
Sandhir B Prasad1, Valerie See, Timothy Tan
1Department of Cardiology, Westmead Hospital, Westmead, Sydney, Australia.
Insights
Serial Doppler echocardiography in ST-elevation myocardial infarction (STEMI) patients reveals abnormal relaxation patterns and persistent diastolic dysfunction, unlike in stable patients. This highlights incomplete recovery after primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Dysfunction
Background:
- Comprehensive Doppler assessment of diastolic dysfunction post-STEMI, including tissue Doppler imaging (TDI), is limited.
- Severe diastolic dysfunction in stable patients typically presents with restrictive mitral filling, reduced annular velocities (E'), and elevated E/E' ratios (>15).
Purpose of the Study:
- To describe temporal changes in Doppler parameters using serial echocardiography in STEMI patients undergoing primary PCI.
- To characterize diastolic dysfunction following STEMI and its recovery trajectory.
Main Methods:
- Prospective assessment of 28 STEMI patients (first-ever STEMI, undergoing PCI) with echocardiography and invasive LVEDP measurements pre-PCI.
- Serial echocardiograms performed at day 3 and 12 months post-PCI.
- Analysis included mitral inflow patterns, TDI-derived E' velocities, and E/E' ratios.
Main Results:
- Elevated LVEDP during STEMI decreased post-revascularization (26.1 ± 6.2 vs. 20.8 ± 5.2 mmHg, P = 0.002).
- Predominant mitral inflow pattern was abnormal relaxation (50%), with restrictive filling in 25%.
- E' velocities were modestly reduced and decreased further by day 3 (septal E' 7.4 ± 2.1 vs. 5.9 ± 1.6 cm/sec, P = 0.002), remaining reduced at 1 year.
Conclusions:
- STEMI patients exhibit abnormal relaxation patterns and E/E' ratios of 8-15, differing from stable patients.
- Serial Doppler assessment indicates incomplete diastolic recovery 1 year post-STEMI.
- Findings suggest persistent diastolic dysfunction following STEMI despite successful revascularization.
Objectives:
We performed serial Doppler echocardiography in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) to describe the temporal changes in Doppler parameters following STEMI.
Background:
Data on comprehensive Doppler assessment of diastolic dysfunction following STEMI, incorporating tissue Doppler imaging (TDI), are lacking. Severe diastolic dysfunction in stable patients usually manifests as a restrictive mitral filling pattern (RFP), reduced TDI-derived annular velocities (E'), and elevated E/E' ratios >15.
Methods:
Twenty-eight patients (19 males, mean age 60 ± 10 years) with a first-ever STEMI who underwent PCI were prospectively assessed with echocardiography and invasive left ventricular end-diastolic pressure (LVEDP) measurements prior to PCI. Repeat echocardiograms were performed at day 3 and 12 months.
Results:
During STEMI: (i) LVEDP was significantly elevated but decreased post revascularization (26.1 ± 6.2 vs. 20.8 ± 5.2 mmHg, P = 0.002); (ii) the predominant mitral inflow pattern was an abnormal relaxation pattern (n = 14 [50%]), whereas restrictive filling pattern was only observed in seven (25%) patients; (iii) E' velocities were only modestly reduced (septal E' 7.4 ± 2.2 cm/sec, lateral E' 9.6 ± 2.2 cm/sec), and (iv) a septal E/E'ratio >15 seen in only one patient, whereas all other patients had an E/E' ratio of 8-15. Serial TDI showed that E'velocity decreased at day 3 (septal E' 7.4 ± 2.1 cm/sec vs. 5.9 ± 1.6 cm/sec, P = 0.002) and remained reduced at 1 year follow-up, suggesting persistence of diastolic dysfunction.
Conclusions:
During STEMI, contrary to findings in stable patients, the predominant Doppler manifestation of the severe diastolic dysfunction and elevated LVEDP was an abnormal relaxation mitral inflow pattern accompanied by E/E' ratios of 8-15. Serial Doppler assessment suggests incomplete diastolic recovery following STEMI.
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