Clinical research: ultrasound imaging in coronary disease
Noninvasive estimation of left ventricular filling pressure by e/e′ is a powerful predictor of survival after acute myocardial infarction

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Abstract

Objectives

The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI).

Background

The early diastolic velocity of the mitral valve annulus (e′) reflects the rate of myocardial relaxation. When combined with measurement of the early transmitral flow velocity (E), the resultant ratio (E/e′) correlates well with mean LVDP. In particular, an E/e′ ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e′ ratio >15 would predict poorer survival after acute MI.

Methods

Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality.

Results

Seventy-three patients (29%) had an E/e′ >15. This was associated with excess mortality (log-rank statistic 21.3, p < 0.0001) and was the most powerful independent predictor of survival (risk ratio 4.8, 95% confidence interval 2.1 to 10.8, p = 0.0002). The addition of E/e′ >15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001).

Conclusions

E/e′ is a powerful predictor of survival after acute MI. An E/e′ ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters.

Abbreviations

CI
confidence interval
DT
deceleration time
E/e′
ratio of early transmitral flow velocity to early diastolic mitral annulus velocity
EF
ejection fraction
LV
left ventricle/ventricular
MI
myocardial infarction
mLVDP
mean left ventricular diastolic pressure
PCWP
pulmonary capillary wedge pressure
RR
risk ratio
WMSI
wall motion score index

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Dr. Hillis was supported by a grant from the British Heart Foundation and Dr. Møller was supported by a grant from the Danish Heart Foundation.