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

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

View larger version (67K): [in a new window]   Figure 1 Transmitral Doppler (top) and tissue Doppler (bottom) imaging of the mitral annulus. The mitral E-wave velocity is 80 cm/s, and the early mitral annulus e' velocity is 8 cm/s, giving an E/e' ratio of 10.

View larger version (13K): [in a new window]   Figure 2 Kaplan-Meier plot demonstrating survival in patients classified according to an E/e' ratio of 15 or >15.

View larger version (13K): [in a new window]   Figure 3 Survival of patients with an E/e' ratio of 15 or >15, stratified according to left ventricular ejection fraction: (A) patients with ejection fraction 40%; (B) patients with ejection fraction >40%.

View larger version (22K): [in a new window]   Figure 4 Incremental value of an E/e' ratio >15 in predicting all-cause mortality. The addition of left ventricular ejection fraction (LVEF), deceleration time (DT), and E/e' resulted in significant incremental improvements in the predictive value of a model including clinical variables (age, Killip class 2 on admission, anterior myocardial infarction, and myocardial revascularization during the index admission): chi-square = 20.8 with 4 degrees of freedom for clinical factors; chi-sqaure = 28.8 with 5 degrees of freedom for clinical factors plus LVEF; chi-square = 33.2 with 6 degrees of freedom for clinical factors plus LVEF plus DT 140 ms; and chi-square = 43.0 with 7 degrees of freedom for clinical factors plus LVEF plus DT 140 ms plus an E/e' ratio <15.