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Abnormal filling pattern of the left ventricle and outcome in acute myocardial infarction
J C García-Rubira1, F Molano, A Espina
1Unidad Coronaria, Hospital Universitario Virgen Macarena, Sevilla, España.
Insights
A specific left ventricular filling pattern (Type III) in acute myocardial infarction predicts a higher mortality risk. Other patterns (Type I and II) showed no significant differences in prognosis, with Type I linked to normal pulmonary wedge pressure.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Infarction
Background:
- Left ventricular filling patterns assessed by Doppler echocardiography are often abnormal following myocardial infarction.
- Understanding these patterns is crucial for predicting patient outcomes.
Purpose of the Study:
- To correlate distinct left ventricular filling patterns with the clinical trajectory of acute myocardial infarction.
- To identify specific Doppler-derived patterns indicative of prognosis.
Main Methods:
- A study involving 133 patients diagnosed with acute myocardial infarction.
- Three mitral flow patterns (Type I, II, III) were defined using Doppler echocardiography based on E/A ratio and E wave deceleration time.
- Pulmonary wedge pressure was measured concurrently with Doppler assessments in a subset of patients.
Main Results:
- Mortality rates varied significantly across the defined patterns: 13% for Type I, 9% for Type II, and 35% for Type III (P=0.007).
- Logistic regression identified Killip class and Type III mitral flow pattern as independent predictors of death (P=0.0004 and P=0.019, respectively).
- Mean pulmonary wedge pressure was significantly higher in Type II (21.0+/-7.3 mmHg) and Type III (22.4+/-7.1 mmHg) compared to Type I (8.4+/-6.1 mmHg).
Conclusions:
- The Type III left ventricular filling pattern serves as an independent predictor of mortality in acute myocardial infarction.
- No significant prognostic differences were observed between Type I and Type II patterns.
- Type I filling pattern is associated with normal pulmonary wedge pressure, suggesting preserved diastolic function.
Background:
The pattern of left ventricular filling by Doppler examination is frequently abnormal in myocardial infarction.
Purpose:
To relate the different patterns of left ventricular filling to the clinical course of acute myocardial infarction.
Patients And Methods:
We have studied 133 patients with acute myocardial infarction. Three different patterns of mitral flow were defined by Doppler examination: Type I has an E/A ratio lesser than one, and a deceleration time of the E wave longer than 180 ms; Type II has either an E/A ratio greater than one or a deceleration time shorter than 180 ms; Type III has an E/A ratio greater than 1.6 and a deceleration time shorter than 180 ms. We also determined the pulmonary wedge pressure through a pulmonary artery catheter simultaneously with the Doppler examination on 22 occasions in 11 patients.
Results:
Mortality rate was 13%, 9% and 35% respectively in Type I, II and III (P=0.007). After logistic regression analysis of determinants of death, including all eight variables related with mortality on an univariate analysis, only Killip class and the presence of a Type III pattern of the mitral flow remained significant (P=0.0004 and P=0.019 respectively). Pulmonary wedge pressure was 8.4+/-6.1 mmHg in Type I, 21.0+/-7.3 mmHg in Type II, and 22.4+/-7.1 mmHg in Type III (P=0.0017).
Conclusion:
Type III pattern of left ventricular filling is an independent predictor of death. Type I and II had no significant differences on prognosis. Type I is associated with a normal pulmonary wedge pressure.