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J Am Coll Cardiol, 2004; 43:1646-1653, doi:10.1016/j.jacc.2003.12.036
© 2004 by the American College of Cardiology Foundation
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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{dagger}, Roberto Latini, MD{ddagger}, Maria G. Franzosi, PhD{ddagger}, 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
{dagger} Ospedale Civile, Pordenone, Italy
{ddagger} 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.

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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