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J Am Coll Cardiol, 2004; 43:360-367, doi:10.1016/j.jacc.2003.07.044
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ULTRASOUND IMAGING IN CORONARY DISEASE

Noninvasive estimation of left ventricular filling pressure by e/e' is a powerful predictor of survival after acute myocardial infarction

Graham S. Hillis, MB, ChB, PhD*, Jacob E. Møller, MD, PhD*, Patricia A. Pellikka, MD, FACC*, Bernard J. Gersh, MB, ChB, DPhil, FACC*, R. Scott Wright, MD, FACC*, Steve R. Ommen, MD, FACC*, Guy S. Reeder, MD, FACC* and Jae K. Oh, MD, FACC*,*

* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received April 21, 2003; revised manuscript received June 10, 2003, accepted July 6, 2003.

* Reprint requests and correspondence: Dr. Jae K. Oh, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
oh.jae{at}mayo.edu

OBJECTIVES: The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI).

BACKGROUND: The early diastolic velocity of the mitral valve annulus (e') reflects the rate of myocardial relaxation. When combined with measurement of the early transmitral flow velocity (E), the resultant ratio (E/e') correlates well with mean LVDP. In particular, an E/e' ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e' ratio >15 would predict poorer survival after acute MI.

METHODS: Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality.

RESULTS: Seventy-three patients (29%) had an E/e' >15. This was associated with excess mortality (log-rank statistic 21.3, p < 0.0001) and was the most powerful independent predictor of survival (risk ratio 4.8, 95% confidence interval 2.1 to 10.8, p = 0.0002). The addition of E/e' >15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001).

CONCLUSIONS: E/e' is a powerful predictor of survival after acute MI. An E/e' ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters.

Abbreviations and Acronyms
  CI = confidence interval
  DT = deceleration time
  E/e' = ratio of early transmitral flow velocity to early diastolic mitral annulus velocity
  EF = ejection fraction
  LV = left ventricle/ventricular
  MI = myocardial infarction
  mLVDP = mean left ventricular diastolic pressure
  PCWP = pulmonary capillary wedge pressure
  RR = risk ratio
  WMSI = wall motion score index




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