Document Detail


Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction.
MedLine Citation:
PMID:  18474816     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Restrictive mitral filling pattern (RFP), the most severe form of diastolic dysfunction, is a predictor of outcome after acute myocardial infarction (AMI). Low power has precluded a definite conclusion on the independent importance of RFP, especially when overall systolic function is preserved. We undertook an individual patient meta-analysis to determine whether RFP is predictive of mortality independently of LV ejection fraction (LVEF), end-systolic volume index, and Killip class in patients after AMI. METHODS AND RESULTS: Twelve prospective studies (3396 patients) assessing the relationship between prognosis and Doppler echocardiographic LV filling pattern in patients after AMI were included. Individual patient data from each study were extracted and collated into a single database for analysis. RFP was associated with higher all-cause mortality (hazard ratio, 2.67; 95% CI, 2.23 to 3.20; P<0.001) and remained an independent predictor in multivariate analysis with age, gender, and LVEF. The overall prevalence of RFP was 20% but was highest (36%) in the quartile of patients with lowest LVEF (<39%) and lowest (9%) in patients with the highest LVEF (>53%; P<0.0001). RFP remained significant within each quartile of LVEF, and no interaction was found for RFP and LVEF (P=0.42). RFP also predicted mortality in patients with above- and below-median end-systolic volume index (1575 patients) and in different Killip classes (1746 patients). Importantly, when diabetes, current medication, and prior AMI were included in the model, RFP remained an independent predictor of outcome. CONCLUSIONS: Restrictive filling is an important independent predictor of mortality after AMI regardless of LVEF, end-systolic volume index, and Killip class.
Authors:
; J E Møller; G A Whalley; F L Dini; R N Doughty; G D Gamble; A L Klein; M Quintana; C M Yu
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't     Date:  2008-05-12
Journal Detail:
Title:  Circulation     Volume:  117     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-20     Completed Date:  2008-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2591-8     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Echocardiography, Doppler
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis*,  mortality
Prognosis
Risk Factors
Stroke Volume
Survival Analysis
Ventricular Dysfunction, Left / mortality*
Investigator
Investigator/Affiliation:
R N Doughty / ; G D Gamble / ; K K Poppe / ; J B Somaratne / ; G A Whalley / ; F L Dini / ; A L Klein / ; J E Møller / ; M Quintana / ; C M Yu / ; M I Burgess / ; G Cerisano / ; M S Feinberg / ; G S Hillis / ; E Kinova / ; K Sakata / ; P L Temporelli / ; H Kozhuharov / ; K Egstrup / ; S H Poulsen / ; E Søndergaard / ; P Atkinson / ; S G Ray / ; S Behar / ; R Beinart / ; V Boyko / ; M Eldar / ; H Hod / ; R Kuperstein / ; S Matetzky / ; A Sagie / ; E Schwammenthal / ; D Antoniucci / ; L Bolognese / ; P Buonamici / ; S Hirata / ; K Ishikawa / ; S Kashiro / ; A Yanagisawa / ; K Kruszewski / ; J Lopez-Sendon / ; D N Sharpe / ; M Edner / ; P Hjemdahl / ; T Kahan / ; N Rehnqvist / ; A Sollevi / ; M G Franzosi / ; F Gentile / ; P Giannuzzi / ; R Latini / ; A P Maggioni / ; G L Nicolosi / ; L Tavazzi / ; G S Andersen / ; U Dahlström / ; O Gøtzsche / ; A Lahiri / ; K Skagen / ; L Køber / ; O Nyvad / ; C Torp-Pedersen /
Comments/Corrections
Comment In:
Circulation. 2008 May 20;117(20):2570-2   [PMID:  18490532 ]

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