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[Long-term follow up of Doppler parameters of ventricular diastolic function after myocardial infarct]
J Salas Nieto1, J Martínez Sánchez, M Villegas García
1Unidad de Cardiología-Hemodinámica, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
Insights
Following myocardial infarction, diastolic function changes significantly within one year. Left ventricular filling patterns shift from early filling (E wave) to atrial contraction (A wave) dominance.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Diastolic dysfunction is a common complication following myocardial infarction.
- Understanding the long-term evolution of diastolic parameters is crucial for patient management.
Purpose of the Study:
- To assess the long-term evolution of diastolic parameters in survivors of a first transmural myocardial infarction.
- To evaluate changes in mitral inflow patterns one year post-infarction without reinfarction or revascularization.
Main Methods:
- Pulsed-Doppler studies of mitral flow were conducted in 42 myocardial infarction survivors.
- Measurements were taken at predischarge and one year later to analyze diastolic parameters.
Main Results:
- A significant decrease in E wave peak velocity was observed (p < 0.001).
- The E/A ratio significantly decreased, shifting from predominantly E wave to A wave filling (p < 0.01).
- Individual analysis revealed persistent changes in the E/A ratio over the follow-up year.
Conclusions:
- The first year after myocardial infarction shows a significant change in left ventricular filling patterns.
- Patterns shift from protodiastolic (E wave) to telediastolic (A wave) dominance.
- These findings highlight the dynamic nature of diastolic function recovery post-infarction.
Abstract:
Forty-two survivors of a first transmural, noncomplicated myocardial infarction underwent mitral flow pulsed-Doppler studies both at predischarge time and 1 year later, in order to assess the long-term evolution of diastolic parameters in the absence of reinfarction or revascularization procedures. Results showed a decrease of mean value of E wave peak velocity (59.6 +/- 14 cm/sec vs 46.8 +/- 13 cm/sec, p < 0.001). Mean value of A wave peak velocity remained stable (59.4 +/- 16 cm/sec vs 58.8 +/- 13 cm/sec, p = 0.86). The mean value of the E/A ratio showed a significant decrease during follow-up from an initial value > or = 1 to a final value < 1 (1.08 +/- 0.4 vs 0.82 +/- 0.2, p < 0.01). From the point of view of individual results, only 8 of 22 patients with an E/A ratio > or = 1 before discharge presented the same ratio value 1 year later, whereas only 1 patient with a E/A ratio < 1 before discharge presented a > 1 value of this ratio in the late study. It is concluded that during the first year of evolution after transmural, nonrevascularized, noncomplicated infarction, the left ventricle filling pattern displays a significant change from predischarge phase (mainly protodiastolic with predominant E wave) to late follow-up (mainly telediastolic with predominant A wave). Different hypotheses to explain these results are discussed.