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[Atrial filling fraction predicts left ventricular systolic function after myocardial infarction: pre-discharge
M Galderisi1, A Fakher, A Petrocelli
1Cattedra di Metodologia Clinica, Facolta di Medicina e Chirurgia, Universita degli Studi Federico II, Napoli.
Insights
This study reveals that atrial contribution is vital for maintaining stroke volume in myocardial infarction patients. Early after myocardial infarction, atrial filling fraction independently predicts stroke volume, highlighting its importance in systolic performance.
Area of Science:
- Cardiology
- Echocardiography
- Physiology
Background:
- Left ventricular diastolic and systolic function are crucial after myocardial infarction.
- Doppler echocardiography provides valuable indices for assessing cardiac function.
- Understanding functional recovery post-myocardial infarction is key for patient management.
Purpose of the Study:
- To investigate the relationship between Doppler-derived diastolic and systolic function indices early after myocardial infarction.
- To identify determinants of left ventricular systolic function in patients recovering from myocardial infarction.
- To explore the role of atrial contribution to stroke volume in this patient group.
Main Methods:
- Fifty-three patients recovering from acute myocardial infarction underwent Doppler echocardiography.
- Twenty-two healthy subjects served as a control group.
- Indices of mitral inflow, left ventricular outflow, and systolic function were measured and analyzed using multilinear regression.
Main Results:
- Myocardial infarction patients exhibited reduced ejection fraction, stroke volume, and cardiac output compared to controls.
- A shortened deceleration time was the only significant difference in Doppler diastolic indices.
- Atrial filling fraction was an independent predictor of stroke volume in myocardial infarction patients.
Conclusions:
- The study confirms pseudonormalization of the diastolic pattern following myocardial infarction.
- Atrial filling fraction plays a significant role in maintaining adequate stroke volume post-myocardial infarction.
- These findings emphasize the importance of atrial contribution to systolic performance in patients with myocardial infarction.
Abstract:
Aim of the study was to examine the relation between Doppler-derived indices of left ventricular diastolic and systolic function early after myocardial infarction. Fifty-three patients (31 males, 22 females) recovering from acute myocardial infarction underwent predischarge Doppler echocardiographic examination. Patients with age > 70 years, previous myocardial infarction, more than mild mitral and aortic regurgitation, mitral and aortic stenosis were excluded. Twenty-two healthy subjects (13 males; 9 females) free of coronary risk factors were selected as the control group. Both end-diastolic and end-systolic volumes and ejection fraction were measured by two-dimensional echocardiography. Pulsed Doppler was used to evaluate mitral inflow and left ventricular outflow velocity patterns. The following indices were measured: peak velocity of early (E) and late (A) flows, ratio of E/A peak velocities, ratio of early to late time velocity integrals, atrial filling fraction (time velocity integral A / time velocity integral of flow during total diastole) and deceleration time of E wave for mitral inflow; peak and time-velocity integral for left ventricular outflow. Stroke volume and cardiac output were obtained by pulsed Doppler using the left ventricular outflow method. The two groups were comparable for age, with blood pressure (p < 0.05) and heart rate (p < 0.01) reduced in myocardial infarction patients. Both end-diastolic and end-systolic volumes were significantly higher (both p < 0.0001) and ejection fraction (p < 0.0001) lower after myocardial infarction. Also stroke volume and cardiac output (both p < 0.0001) were reduced in myocardial infarction patients. No significant difference in Doppler indices of diastolic function was observed between the two groups, except for shortened deceleration time (p < 0.0001) in myocardial infarction patients. Multilinear regression analyses were performed separately into the two groups to identify determinants of left ventricular systolic function. After adjusting for age, heart rate, systolic blood pressure and both end-diastolic and end-systolic volumes, atrial filling fraction was an independent predictor of stroke volume, with a direct relation (beta coefficient = 0.53, p < 0.001), in myocardial infarction patients but not in health subjects. In conclusion, our study confirms the pseudonormalization of diastolic pattern after myocardial infarction. The direct relation between atrial filling fraction and stroke volume indicates the importance of atrial contribution to maintain an adequate systolic performance in patients with myocardial infarction.