Related Experiment Video
Updated: Dec 17, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Determinants of Diastolic Dysfunction Following Myocardial Infarction: Evidence for Causation Beyond Infarct Size
Sandhir B Prasad1, Andrew Lin2, Christopher Kwan2
1Department of Cardiology, Royal Brisbane and Women's Hospital, and University of Queensland School of Medicine, Brisbane, Qld, Australia; Griffith University School of Medicine, Brisbane, Qld, Australia.
Insights
Infarct size significantly impacts severe diastolic dysfunction after myocardial infarction (MI). However, other factors like diabetes also contribute, especially in patients with preserved ejection fraction.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function
Background:
- Severe diastolic dysfunction (DD) following myocardial infarction (MI) has unclear determinants.
- This study investigates factors contributing to severe DD, specifically restrictive mitral inflow pattern (RFP), post-MI.
Purpose of the Study:
- To identify the determinants of severe diastolic dysfunction (RFP) after myocardial infarction.
- To assess the specific impact of infarct size on the development of severe DD.
Main Methods:
- Retrospective analysis of 477 patients with first-ever MI (NSTEMI or STEMI).
- Infarct size assessed by peak troponin-I (Peak-TnI); left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) used as surrogates.
- Echocardiography performed within 24 hours; RFP defined by specific E/A ratio and deceleration time criteria.
Main Results:
- 14.5% of patients (69) exhibited RFP.
- Higher Peak-TnI levels, WMSI, and lower LVEF were independent predictors of RFP.
- Diabetes was also an independent predictor of RFP.
Conclusions:
- Infarct size is a key determinant of severe diastolic dysfunction post-MI.
- A subset of patients develop severe DD with small infarcts and preserved LVEF, suggesting other factors like pre-existing DD due to diabetes are crucial.
Background:
The determinants of severe diastolic dysfunction (DD) following myocardial infarction (MI) are not well defined. This study sought to define the determinants of severe DD (restrictive mitral inflow pattern on Doppler echocardiography [RFP]) in patients with a first-ever MI, with particular emphasis on the impact of infarct size.
Methods:
Retrospective single-centre study including consecutive patients admitted to a tertiary referral centre with a first-ever non-ST-elevation-MI (NSTEMI) or ST-elevation-MI (STEMI) (n=477). Peak troponin-I (Peak-TnI) was used as the principal measure of infarct size, whilst left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were regarded as surrogate measures. Echocardiography was performed within 24 hours of admission for all patients. RFP was defined as E/A ratio >2.0 or E/A ratio >1.5 and E-wave deceleration time <140 ms.
Results:
A total of 69 patients (14.5%) had RFP. Peak-TnI levels were higher in the RFP group (32.6±32.7 versus 16.9±25.2 μg/L, p<0.001). In sequential multivariable models incorporating significant clinical, angiographic and left ventricular (LV) size-related variables, Peak-TnI (OR 1.98, p=0.001), WMSI (OR 2.34, p=0.048) and LVEF (OR 0.97, p=0.044) were independent predictors of RFP. Presence of diabetes was also an independent predictor in all the models constructed. When patients were stratified according to an LVEF of 50%, 39% of RFP patients had a preserved LVEF (RFP/preserved EF group), and these patients had lower Peak-TnI levels compared to the RFP/reduced EF group (14.4±18.7 vs 44.5±35.5 μg/L).
Conclusions:
Whilst infarct size is a major determinant of severe diastolic dysfunction after MI, a significant subset of patients develop severe diastolic dysfunction despite a small infarct size and preserved LVEF, highlighting that other factors such as pre-existing diastolic dysfunction due to risk factors such as diabetes have an important role in causation.
More Related Videos
09:37Permanent Ligation of the Left Anterior Descending Coronary Artery in Mice: A Model of Post-myocardial Infarction Remodelling and Heart Failure
Published on: December 2, 2014
11:04Quantification of Global Diastolic Function by Kinematic Modeling-based Analysis of Transmitral Flow via the Parametrized Diastolic Filling Formalism
Published on: September 1, 2014
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:30Coronary Artery Disease I: Introduction
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:17Pathophysiology of Heart Failure
01:21Myocarditis I: Introduction