Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide

Kirsten Kruszewski, Anne Scott, Justin Lee Barclay, Gary Robert Small, Bernard L. Croal, Graham Scott Hillis

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background
Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this.

Methods
Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years).

Results
Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both).

Conclusions
The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.

Original languageEnglish
Pages (from-to)47-54
Number of pages8
JournalAmerican Heart Journal
Volume159
Issue number1
Early online date16 Dec 2009
DOIs
Publication statusPublished - 1 Jan 2010

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