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Prognostic value of Doppler transmitral flow velocity patterns in acute myocardial infarction
K Sakata1, S Kashiro, S Hirata
1Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
Insights
Reduced atrial contraction flow velocity in acute myocardial infarction (AMI) patients indicates left ventricular dysfunction. This Doppler finding predicts higher mortality and heart failure incidence, highlighting its prognostic value.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction Research
Background:
- Doppler transmitral flow patterns exhibit age-dependent variations.
- Understanding transmitral flow patterns in acute myocardial infarction (AMI) is crucial for prognosis.
- Age-adjusted transmitral flow analysis may reveal underlying hemodynamic changes.
Purpose of the Study:
- To investigate the correlation between age-adjusted transmitral flow patterns and clinical outcomes in AMI patients.
- To assess the relationship between transmitral flow patterns, hemodynamic indexes, and prognosis post-AMI.
- To identify specific transmitral flow patterns indicative of left ventricular dysfunction.
Main Methods:
- Retrospective analysis of 206 AMI patients and 102 controls.
- Assessment of age-adjusted Doppler transmitral flow patterns, including peak flow velocity at atrial contraction (low-A group).
- Measurement of hemodynamic indexes: pulmonary capillary wedge pressure, cardiac index, and left ventricular ejection fraction.
- Correlation with clinical outcomes: cardiogenic shock, in-hospital mortality, heart failure incidence, and 5-year mortality.
Main Results:
- A subset of AMI patients (24%) demonstrated significantly lower peak flow velocity at atrial contraction (low-A group).
- The low-A group exhibited higher pulmonary capillary wedge pressure and lower cardiac index and left ventricular ejection fraction.
- Cardiogenic shock incidence was significantly higher in the low-A group (42% vs 19%).
- Decreased atrial filling velocity strongly correlated with increased in-hospital mortality, heart failure, and 5-year mortality.
Conclusions:
- Age-adjusted transmitral flow patterns, specifically reduced atrial filling velocity, can identify left ventricular dysfunction in AMI.
- This Doppler-derived pattern serves as a valuable prognostic marker for adverse clinical outcomes, including mortality and heart failure.
- Transmitral flow analysis offers a non-invasive method to stratify risk in patients following acute myocardial infarction.
Abstract:
Doppler transmitral flow patterns are partially dependent on age. We investigated the correlations between the age-adjusted transmitral flow patterns, hemodynamic indexes, and the coronary and clinical outcome in 206 patients with acute myocardial infarction (AMI) and 102 normal control subjects. The peak flow velocity at atrial contraction was significantly lower in 50 of the 206 patients (24%) (low-A group) than in the 102 normal controls. Pulmonary capillary wedge pressure was significantly higher in the low-A group than in the remaining 156 patients with AMI (20 +/- 7 vs 11 +/- 5 mm Hg, p <0.001), and the cardiac index and left ventricular ejection fraction were significantly lower (2.2 +/- 0.6 vs 2.9 +/- 0.7 L/min/m2, p <0.001; 38 +/- 15% vs 52 +/- 13%, p <0.001). The incidence of cardiogenic shock was significantly higher in the low-A group than in the other patients with AMI (42% vs 19%, p <0.001). Regression analysis demonstrated a significant association between decreased atrial filling velocity and increased in-hospital mortality as well as the incidence of heart failure in AMI (p <0.001). The 5-year mortality rate was also significantly higher in the low-A group (p <0.001). The age-adjusted transmitral flow pattern in AMI can identify patients with left ventricular dysfunction, which can lead to a poor prognosis.