Journal of the American Society of Echocardiography
Clinical InvestigationDiastolic Function After Myocardial InfarctionDiastolic Dysfunction Assessed Using Contemporary Guidelines and Prognosis Following Myocardial Infarction
Section snippets
Study Overview
A total of 718 consecutive patients with MI (ST-segment elevation MI [STEMI] and non–ST-segment elevation MI [NSTEMI]) who underwent coronary angiography during the study period between January 2013 and December 2014 at a single tertiary-level referral center (Royal Brisbane and Women's Hospital) were considered for inclusion in this study. Exclusion criteria were previous MI, significant mitral valve disease (greater than moderate regurgitation or any stenosis or a prosthetic valve), atrial
Results
Patient flow data are shown in Figure 1. From the 718 consecutive patients with MI considered for inclusion, exclusions totaled 299, as listed in Figure 1, leaving a final study group of 419 patients. Of note, 36 patients (8.6%) were excluded because DD was indeterminate using the 2016 guidelines, and 16 patients (3.8%) were excluded because DD was indeterminate using the 2009 guidelines. Baseline clinical and angiographic characteristics of study patients are shown in Table 1.
Discussion
The main finding of this study is that DD assessed using the novel diagnostic algorithm recommended in the 2016 ASE/EACVI guidelines for the assessment of diastolic function is a robust independent predictor of outcomes following MI. In addition, this study also demonstrates that the prognostic value of the aggregate assessment of DD using the algorithms recommended in the 2016 guidelines compares favorably with the prognostic value of any of the individual parameters incorporated in the
Conclusion
This study demonstrates that significant DD assessed by the algorithms recommended in the 2016 ASE/EACVI guidelines for the assessment of diastolic function, is a robust independent predictor of MACEs in patients with first ever MI and compares favorably with the prognostic value of significant DD assessed by 2009 ASE/EAE guidelines, as well as the prognostic value of the individual parameters incorporated into the guidelines.
Acknowledgments
The contributions of James Armstrong and Kym Smith for performing the echocardiographic measurements, Jo-anne Sippel for database management, and Drs. Christopher Hammett, Peter Stewart, and Rajesh Shetty for access to the catheterization data are gratefully acknowledged.
References (25)
- et al.
Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: prognostic and clinical implications
J Am Coll Cardiol
(2000) - et al.
Prognostic implications of restrictive left ventricular filling in reperfused anterior acute myocardial infarction
J Am Coll Cardiol
(2001) - et al.
Prognostic importance of systolic and diastolic function after acute myocardial infarction
Am Heart J
(2003) - et al.
Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: a serial Doppler echocardiographic study
J Am Coll Cardiol
(1997) - et al.
Individual patient meta-analyses of restrictive diastolic filling pattern and mortality in patients post acute myocardial infarction and in patients with chronic heart failure. Meta-Analysis Research Group in Echocardiography (MeRGE) collaborators
Int J Cardiol
(2007) - et al.
Noninvasive estimation of left ventricular filling pressure by E/e′ is a powerful predictor of survival after acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction: a serial color M-mode Doppler echocardiographic study
J Am Coll Cardiol
(2000) - et al.
Pseudonormal mitral filling is associated with similarly poor prognosis as restrictive filling in patients with heart failure and coronary heart disease: a systematic review and meta-analysis of prospective studies
J Am Soc Echocardiogr
(2009) - et al.
Long-term prognostic significance of left atrial volume in acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Recommendations for the evaluation of left ventricular diastolic function by echocardiography
J Am Soc Echocardiogr
(2009)
Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
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Conflicts of Interest: None.