CLINICAL RESEARCH: DOPPLER ASSESSMENT OF LV FUNCTION
Doppler-derived mitral deceleration time as a strong prognostic marker of left ventricular remodeling and survival after acute myocardial infarction
Results of the GISSI-3 Echo substudy
Pier L. Temporelli, MD*,*,
Pantaleo Giannuzzi, MD*,
Gian L. Nicolosi, MD ,
Roberto Latini, MD ,
Maria G. Franzosi, PhD,
Francesco Gentile, MD ,
Luigi Tavazzi, MD||,
Aldo P. Maggioni, MD¶ GISSI-3 Echo Substudy Investigators
* Fondazione Salvatore Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Veruno, Italy
Ospedale Civile, Pordenone, Italy
Istituto di Ricerche Farmacologiche "Mario Negri," Milano, Italy
Ospedale Bassini, Cinisello Balsamo, Italy
|| Ospedale S. Matteo, Pavia, Italy
¶ Centro Studi ANMCO, Firenze, Italy
Manuscript received January 28, 2002;
revised manuscript received December 6, 2003,
accepted December 16, 2003.
* Reprint requests and correspondence: Dr. Pier L. Temporelli, Fondazione "Salvatore Maugeri," IRCCS, Via Revislate, 13, 28010 Veruno (NO), Italy.
ptemporelli{at}fsm.it
OBJECTIVES: The goal of this study was to assess the impact of left ventricular (LV) diastolic filling on remodeling and survival after acute myocardial infarction (AMI).
BACKGROUND: Little is known regarding the link between LV filling, its changes over time, and six-month remodeling and late survival in uncomplicated AMI.
METHODS: Doppler mitral profile, end-diastolic volume index (EDVi) and end-systolic volume index (ESVi), ejection fraction (EF), and wall motion abnormalities (%WMA) were evaluated in 571 patients from the GISSI-3 Echo substudy at baseline, pre-discharge, and six months after AMI. Patients with baseline early mitral deceleration time (DT) 130 ms were assigned to the restrictive group (n = 147), and those with DT >130 ms to the nonrestrictive group (n = 424).
RESULTS: Restrictive group patients had greater baseline ESVi and %WMA and lower EF than nonrestrictive group, and six-month greater LV dilation (EDVi, ESVi: p < 0.001 for EDVi and ESVi), smaller decrease in %WMA decrease (p < 0.01), and larger EF impairment (p < 0.008). Among the restrictive group, patients (n = 56) with pre-discharge persistent restrictive filling (n = 56) showed six-month greater LV enlargement (p < 0.001) and EF impairment (p < 0.009) than those (n = 91) with reversible restrictive filling. Baseline %WMA and EDVi, together with pre-discharge persistent restrictive filling, predicted severe (>20%) LV dilation. Four-year survival was 93% in nonrestrictive patients versus 88% in the restrictive group (p < 0.06), and 93% in pre-discharge reversible restrictive versus 79% in persistent restrictive (p < 0.0003). The single best predictor of mortality, by Cox analysis, was pre-discharge persistent restrictive filling (chi-square 14.88).
CONCLUSIONS: Left ventricular dilation may occur even after uncomplicated AMI and may be paralleled by an improvement in LV filling. However, a baseline restrictive filling that persists at pre-discharge identifies more compromised patients at higher risk for six-month remodeling and four-year mortality.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | DT | = deceleration time of early filling | | EDVi | = end-diastolic volume index | | EF | = ejection fraction | | ESVi | = end-systolic volume index | | GISSI | = Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto | | LV | = left ventricle or left ventricular | | OR | = odds ratio | | %WMA | = extent of wall motion abnormalities |
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