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CLINICAL STUDY: MYOCARDIAL INFARCTION

Prognostic implications of restrictive left ventricular filling in reperfused anterior acute myocardial infarction

^a Division of Cardiology, Careggi Hospital, Florence, Italy

Manuscript received June 1, 2000; revised manuscript received October 24, 2000, accepted November 29, 2000.

Reprint requests and correspondence: Dr. Giampaolo Cerisano, Division of Cardiology, Careggi Hospital, Viale Morgagni 85, 50134 Firenze, Italy
carddept{at}tin.it

OBJECTIVES

We sought to assess the relative prognostic role of a restrictive left ventricular (LV) filling pattern after a first anterior acute myocardial infarction (AMI) in patients treated with primary percutaneous transluminal coronary angioplasty (PTCA).

BACKGROUND

In thrombolized patients, a short Doppler-derived mitral deceleration time (DT) of early filling is a powerful independent predictor of heart failure and death. However, it is still unknown whether the outcome of patients with AMI with a short DT may be improved by a more aggressive treatment.

METHODS

In 104 patients, two-dimensional and Doppler echocardiograms were obtained three days after the index AMI. Coronary angiography was performed in all patients one and six months after PTCA. The patients were classified into two groups according to the DT duration: group 1 (n = 34) with DT 130 ms and group 2 (n = 70) with DT >130 ms. All patients were followed-up for a mean (±SD) period of 32 ± 10 months.

RESULTS

During the follow-up period, 14 patients (13%) were admitted to the hospital for congestive heart failure, and 9 patients (9%) died. All cardiac deaths (n = 7) occurred in group 1. The survival rate at mean follow-up was 79% in group 1 and 97.2% in group 2 (p = 0.003). Multivariate Cox analysis showed that only age and restrictive filling were independent predictors of event-free survival. Furthermore, when survival with no cardiovascular events was analyzed, a short DT still emerged as the most powerful independent predictor.

CONCLUSIONS

Patients with a restrictive LV filling pattern early after anterior AMI have a poor clinical outcome, even if treated with primary PTCA.

Abbreviations and Acronyms   A = peak velocity of late diastolic filling wave   AMI = acute myocardial infarction   DT = (early filling) deceleration time   E = peak velocity of early diastolic filling wave   LV = left ventricular   LVEF = left ventricular ejection fraction   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis In Myocardial Infarction trial   WMSI = wall motion score index

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