Document Detail


E/e' Two Weeks after Onset Is a Powerful Predictor of Cardiac Death and Heart Failure in Patients with a First-Time ST Elevation Acute Myocardial Infarction.
MedLine Citation:
PMID:  23200417     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Early transmitral flow velocity (E) divided by early diastolic velocity of the mitral valve annulus (e') is referred to as the E/e' ratio, a variable that strongly correlates with mean left ventricular filling pressure. E/e' obtained at acute phase has been reported as useful in predicting prognosis in patients with acute myocardial infarctions. The aim of this study was to evaluate the clinical utility of echocardiographic indices obtained 2 weeks after the onset of a first ST-segment elevation myocardial infarction as predictors of outcomes.
METHODS: Echocardiography was performed and blood samples were obtained from 301 consecutive patients 2 weeks after the onset of a first ST-segment elevation myocardial infarction. All patients underwent primary percutaneous coronary intervention <12 hours after symptom onset and were followed for 51.7 ± 19.0 months. The primary end point was cardiac death or readmission for heart failure.
RESULTS: During follow-up, cardiac death occurred in 10 patients, and heart failure developed in 35. On univariate analysis, age > 75 years, plasma brain natriuretic peptide > 180 pg/mL, early diastolic/late diastolic wave velocity of mitral inflow > 1.0, mitral inflow deceleration time < 140 msec, and E/e' > 15 were associated with the primary end points. Multivariate analysis showed that E/e' > 15 was the strongest predictor (hazard ratio, 3.702; 95% confidence interval, 1.895-7.391; P = .0001), followed by early diastolic/late diastolic wave velocity of mitral inflow > 1.0 (hazard ratio, 3.053; 95% confidence interval, 1.584-6.125; P = .008). Predictive accuracy was further enhanced by combing E/e' > 15 and early diastolic/late diastolic wave velocity of mitral inflow > 1.0 (hazard ratio, 7.373; 95% confidence interval, 3.529-16.528; P < .0001).
CONCLUSIONS: E/e' > 15 obtained 2 weeks after onset is the strongest predictor of cardiac death and readmission for heart failure after a reperfused first ST-segment elevation myocardial infarction. The predictive value of E/e' at 2 weeks is further enhanced by combining this variable with mitral inflow filling pattern.
Authors:
Noriaki Iwahashi; Kazuo Kimura; Masami Kosuge; Kengo Tsukahara; Kiyoshi Hibi; Toshiaki Ebina; Mari Saito; Satoshi Umemura
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  25     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1290-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. Electronic address: iwahashi@ra2.so-net.ne.jp.
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