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Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: a serial Doppler
F Nijland1, O Kamp, A J Karreman
1Department of Cardiology and Institute for Cardiovascular Research, Free University Hospital, Amsterdam, The Netherlands. cardiol@azvu.nl
Insights
Restrictive left ventricular (LV) filling after myocardial infarction is a strong predictor of cardiac death. This finding provides crucial prognostic information beyond standard systolic dysfunction assessments.
Area of Science:
- Cardiology
- Echocardiography
- Prognostic Biomarkers
Background:
- Limited data exists on diastolic dysfunction's prognostic impact post-myocardial infarction.
- The added value of diastolic dysfunction assessment over systolic dysfunction is unknown.
Purpose of the Study:
- To evaluate the prognostic significance of restrictive left ventricular (LV) filling after acute myocardial infarction.
- To determine if restrictive LV filling provides additional prognostic information beyond systolic dysfunction.
Main Methods:
- Serial Doppler echocardiography in 95 patients post-myocardial infarction.
- Classification into restrictive (n=12) and nonrestrictive (n=83) LV filling groups based on E/A ratio and deceleration time.
- Follow-up for cardiac death over a mean of 32 months.
Main Results:
- Restrictive LV filling was the single best predictor of cardiac death (p < 0.0001).
- 1-year survival was 50% in the restrictive group vs. 100% in the nonrestrictive group.
- 3-year survival was 22% in the restrictive group vs. 100% in the nonrestrictive group.
Conclusions:
- Restrictive LV filling is the strongest predictor of cardiac death after acute myocardial infarction.
- Restrictive filling significantly enhances prognostic information from systolic dysfunction markers.
Objectives:
This study was designed to evaluate the relative prognostic significance of restrictive left ventricular (LV) filling after acute myocardial infarction.
Background:
Data regarding the contribution of diastolic dysfunction to prognosis after myocardial infarction are limited, and the additional value over the assessment of systolic dysfunction is not known.
Methods:
Serial Doppler echocardiography was performed in 95 patients on days 1, 3 and 7 and 3 months after acute myocardial infarction. Patients were classified into two groups: a restrictive group (n = 12) with a peak velocity of early diastolic filling wave (E)/peak velocity of late filling wave (A) ratio > or = 2 or between 1 and 2 and a deceleration time (DT) < or = 140 ms during at least one echocardiographic study; and a nonrestrictive group (n = 83) with an E/A ratio < or = 1 or between 1 and 2 and a DT > 140 ms at all examinations.
Results:
Cardiac death occurred in 10 patients during a mean follow-up interval of 32 +/- 17 months. The survival rate at 1 year was 100% in the nonrestrictive group and only 50% in the restrictive group. After 1 year there was a continuing divergence of mortality, resulting in a 3-year survival rate of 100% and 22%, respectively. Univariate Cox analysis revealed that restrictive LV filling, wall motion score index, ejection fraction and end-systolic and end-diastolic volume indexes, as well as peak creatine kinase, peak MB fraction and heart failure during the hospital course were significant predictors of cardiac death, although restrictive filling was the single best predictor (p < 0.0001). Multivariate analysis showed that restrictive filling adds prognostic information to clinical and echocardiographic variables of systolic dysfunction.
Conclusions:
Restrictive LV filling after acute myocardial infarction is the single best predictor of cardiac death and adds significantly to clinical and echocardiographic markers of systolic dysfunction.