CARDIOVASCULAR MEDICINE

Restrictive diastolic filling predicts death after acute myocardial infarction: systematic review and meta-analysis of prospective studies

G A Whalley, G D Gamble, R N Doughty

Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

Correspondence to:
Gillian Whalley
Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92 019, Auckland, New Zealand; g.whalley{at}auckland.ac.nz

Objective: To determine, through a systematic review and meta-analysis, the magnitude of the survival deficit associated with a restrictive filling pattern after acute myocardial infarction (AMI).

Methods: Online databases were searched for prospective echocardiography outcome studies of patients after AMI. All authors were contacted to seek confirmation of their data. Restrictive filling was compared with all non-restrictive filling patterns. Review Manager Version 4.2.7 software was used for analysis.

Results: 3855 patients in 16 studies were identified. Follow up varied from two weeks to five years (> 1 year, 10 studies; and > 4 years, four studies). 776 (20%) of patients had a restrictive filling pattern at baseline. 580 patients died (247 in the restrictive group), and the overall odds ratio for death (restrictive filling worse) was 4.10 (95% confidence interval 3.38 to 4.99).

Conclusions: Mortality is about four times higher in patients with a restrictive filling pattern than in those with non-restrictive filling patterns after AMI. Echocardiographic assessment of diastolic filling pattern is an important part of the echocardiographic assessment of patients after myocardial infarction and provides important prognostic information about such patients.

Abbreviations: AMI, acute myocardial infarction; HF, heart failure; LV, left ventricular

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