CLINICAL STUDIES
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
Jacob E. Møller, MD*,
Eva Søndergaard, MD*,
James B. Seward, MD, FACC ,
Christopher P. Appleton, MD, FACC and
Kenneth Egstrup, MD, DMSci, FESC*
* Department of Medicine, Svendborg Hospital, Svendborg, Denmark
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona, USA
Manuscript received December 31, 1998;
revised manuscript received September 10, 1999,
accepted October 27, 1999.
Reprint requests and correspondence: Dr. Jacob E. Møller, Department of Medicine, Svendborg Hospital, 5700 Svendborg, Denmark
jam{at}shf.fyns-amt.dk
OBJECTIVES
To determine the ability of the ratio of peak E-wave velocity to flow propagation velocity (E/Vp) measured with color M-mode Doppler echocardiography to predict in-hospital heart failure and cardiac mortality in an unselected consecutive population with first myocardial infarction (MI).
BACKGROUND
Several experimental studies indicate color M-mode echocardiography to be a valuable tool in the evaluation of diastolic function, but data regarding the clinical value are lacking.
METHODS
Echocardiography was performed within 24 h of arrival at the coronary care unit in 110 consecutive patients with first MI. Highest Killip class was determined during hospitalization. Patients were divided into groups according to E/Vp <1.5 and  1.5.
RESULTS
During hospitalization 53 patients were in Killip class II. In patients with E/Vp 1.5, Killip class was significantly higher compared with patients with E/Vp <1.5 (p < 0.0001). Multivariate logistic regression analysis identified E/Vp 1.5 to be the single best predictor of in-hospital clinical heart failure when compared with age, heart rate, E-wave deceleration time (Dt), left ventricular (LV) ejection fraction, wall motion index, enzymatic infarct size and Q-wave MI. At day 35 survival in patients with E/Vp <1.5 was 98%, while for patients with E/Vp 1.5, it was 58% (p < 0.0001). Cox proportional hazards model identified Dt <140 ms, E/Vp 1.5 and age to be independent predictors of cardiac death, with Dt < 140 ms being superior to age and E/Vp.
CONCLUSIONS
In the acute phase of MI, E/Vp 1.5 measured with color M-mode echocardiography is a strong predictor of in-hospital heart failure. Furthermore, E/Vp is superior to systolic measurements in predicting 35 day survival although Dt <140 ms is the most powerful predictor of cardiac death.
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Abbreviations and Acronyms
| | Dt | = E-wave deceleration time | | E | = peak E-wave velocity | | E/Vp | = the ratio of E to Vp | | LV | = left ventricular | | LVEDP | = left ventricular end diastolic pressure | | MI | = myocardial infarction | | tau | = time constant of isovolumetric relaxation | | Vp | = flow propagation velocity | | WMI | = wall motion index |
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