Background In patients with acute myocardial infarction (AMI), diastolic function provides important prognostic information that is incremental to systolic function. Unlike other Doppler parameters of diastolic function, early mitral annulus velocity, e′ appears to be relatively independent of preload. In addition, the ratio of early transmitral flow velocity, E to e′, E/e′ has been shown to be the most accurate predictor of left ventricle (LV) filling pressure.
Objectives The aim of this study was to determine the prognostic significance of E/e’ ratio obtained by tissue Doppler imaging (TDI) among patients admitted for unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) in relation to the development of congestive heart failure (CHF).
Methods 53 patients admitted with a diagnosis of NSTEMI or UA had transthoracic echocardiogram done within 72 h from admission. The patients were followed up during hospital stay. The end-point was ocurrence of CHF.
Results The computed cut off value for E/e′ ratio that would predict the development of CHF during hospital admission was 11.4. Twenty three (46%) patients had an E/e’ ratio > 11.4. During hospital stay of a mean of 12.04±9.92 days, 18 patients (34%) had congestive heart failure. In a stepwise multivariable model, the most powerful independent prognostic indicator for the development of CHF was an E/e′ ratio > 11.4 (OR 5.45, 95% CI 1.07 to 53.00, p=0.050). The other independent predictors were history of smoking and diabetes mellitus (OR 2.69, 95% CI 1.80 to 40.36, p=0.017), use of statins (OR 0.01, 95% CI 0.00 to 0.37, p=0.015), PVS (OR 0.89, 95% CI 0.80 to 0.99, p=0.026) and PVD (OR 1.21, 95% CI 1.04 to 1.41, p=0.013).
Conclusion An E/e′>11.4 is a good predictor of the ocurrence of heart failure in patients with NSTEMI or UA.