Prognostic value of E/e' ratio and its change over time in ST-segment elevation myocardial infarction with preserved...

Area of Science:

• Cardiology
• Echocardiography
• Clinical Outcomes

Background:

• The ratio of early diastolic mitral inflow velocity to mitral annular velocity (E/e') is a prognostic indicator in ST-segment elevation myocardial infarction (STEMI) patients.
• Limited data exist on long-term outcomes and E/e' changes in STEMI patients with preserved left ventricular ejection fraction (LVEF) post-reperfusion.

Purpose of the Study:

• To investigate the long-term prognostic value of E/e' in STEMI patients with LVEF ≥40% after primary percutaneous coronary intervention (PCI).
• To analyze longitudinal changes in E/e' and their association with clinical outcomes in this patient cohort.

Main Methods:

• An echocardiographic substudy of a randomized controlled trial involving STEMI patients with LVEF ≥40% post-PCI.
• Patients were stratified by discharge E/e' (≤14: normal; >14: high).
• Primary outcome: composite of death, MI, stroke, ACS, and HF hospitalization. Landmark analysis at 1 year.

Main Results:

• The high E/e' group (n=38) had a significantly higher incidence of the primary outcome compared to the normal E/e' group (n=173) over a median follow-up of 3.9 years (26.3% vs. 11.0%).
• Log-rank analysis showed a higher cumulative incidence of the primary outcome in the high E/e' group (21.9% vs. 7.1% at 3 years, p=0.013).
• E/e' decreased in the high E/e' group but remained elevated at 1 year (13.7±5.3 vs. 8.6±2.3, p<0.001), and E/e' >14 at 1 year predicted poor outcomes (p=0.008).

Conclusions:

• Elevated discharge E/e' is associated with adverse long-term outcomes in STEMI patients with preserved LVEF post-PCI.
• Persistent elevation of E/e' late after STEMI may contribute to these poor outcomes.
• E/e' is a valuable prognostic marker in this specific patient population.