Clinical research: Doppler assessment of LV function
Doppler-derived mitral deceleration time as a strong prognostic marker of left ventricular remodeling and survival after acute myocardial infarction: Results of the GISSI-3 Echo substudy☆
The goal of this study was to assess the impact of left ventricular (LV) diastolic filling on remodeling and survival after acute myocardial infarction (AMI).
Background
Little is known regarding the link between LV filling, its changes over time, and six-month remodeling and late survival in uncomplicated AMI.
Methods
Doppler mitral profile, end-diastolic volume index (EDVi) and end-systolic volume index (ESVi), ejection fraction (EF), and wall motion abnormalities (%WMA) were evaluated in 571 patients from the GISSI-3 Echo substudy at baseline, pre-discharge, and six months after AMI. Patients with baseline early mitral deceleration time (DT) 130 ms were assigned to the restrictive group (n = 147), and those with DT >130 ms to the nonrestrictive group (n = 424).
Results
Restrictive group patients had greater baseline ESVi and %WMA and lower EF than nonrestrictive group, and six-month greater LV dilation (EDVi, ESVi: p < 0.001 for EDVi and ESVi), smaller decrease in %WMA decrease (p < 0.01), and larger EF impairment (p < 0.008). Among the restrictive group, patients (n = 56) with pre-discharge persistent restrictive filling (n = 56) showed six-month greater LV enlargement (p < 0.001) and EF impairment (p < 0.009) than those (n = 91) with reversible restrictive filling. Baseline %WMA and EDVi, together with pre-discharge persistent restrictive filling, predicted severe (>20%) LV dilation. Four-year survival was 93% in nonrestrictive patients versus 88% in the restrictive group (p < 0.06), and 93% in pre-discharge reversible restrictive versus 79% in persistent restrictive (p < 0.0003). The single best predictor of mortality, by Cox analysis, was pre-discharge persistent restrictive filling (chi-square 14.88).
Conclusions
Left ventricular dilation may occur even after uncomplicated AMI and may be paralleled by an improvement in LV filling. However, a baseline restrictive filling that persists at pre-discharge identifies more compromised patients at higher risk for six-month remodeling and four-year mortality.
Abbreviations
AMI
acute myocardial infarction
DT
deceleration time of early filling
EDVi
end-diastolic volume index
EF
ejection fraction
ESVi
end-systolic volume index
GISSI
Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto
For a list of GISSI investigators, see the Appendix of reference 8.
GISSI is endorsed by the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO, Italy) and the Istituto di Ricerche Farmacologiche “Mario Negri,” Milan, Italy.