Association Between the Mitral Annular E/e' Ratio and In-Hospital Mortality in Acute ST-Elevation Myocardial...

Area of Science:

• Cardiology
• Echocardiography
• Acute Myocardial Infarction

Background:

• Left ventricular (LV) diastolic dysfunction and elevated LV filling pressures are linked to poor outcomes in acute ST-elevation myocardial infarction (STEMI).
• The mitral annular E/e' ratio, derived from tissue Doppler imaging, estimates LV filling pressure noninvasively.
• The prognostic significance of early E/e' ratio measurement post-STEMI admission is not well-established.

Purpose of the Study:

• To assess the association between the early mitral annular E/e' ratio and in-hospital mortality in patients with acute STEMI.

Main Methods:

• Prospective observational study of 256 consecutive STEMI patients.
• Transthoracic echocardiography with tissue Doppler imaging performed within 24 hours of admission.
• Measurement of mitral inflow velocities (E, A), mitral annular early diastolic velocity (e'), and calculation of the E/e' ratio.

Main Results:

• 30% of patients (n=77) had an elevated E/e' ratio (>15), indicating increased LV filling pressures.
• In-hospital mortality was significantly higher in patients with E/e' >15 (34%) versus E/e' ≤15 (4%) (p=0.002).
• Elevated E/e' was independently associated with in-hospital mortality, alongside Killip class ≥II.

Conclusions:

• An elevated mitral annular E/e' ratio measured early after STEMI admission is a strong, independent predictor of in-hospital mortality.
• The E/e' ratio provides valuable prognostic information, complementing the Killip class.
• Early E/e' measurement can enhance bedside risk stratification for STEMI patients.