Non-invasive estimation of left ventricular filling pressure by E/e' is a powerful predictor of survival after acute myocardial infarction

Graham Scott Hillis, J. E. Moller, P. A. Pellikka, B. J. Gersh, R. S. Wright, S. R. Ommen, G. S. Reeder, J. K. Oh

    Research output: Contribution to journalArticle

    394 Citations (Scopus)

    Abstract

    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 transmittal 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. (C) 2004 by the American College of Cardiology Foundation.

    Original languageEnglish
    Pages (from-to)360-367
    Number of pages7
    JournalJournal of the American College of Cardiology
    Volume43
    Issue number3
    DOIs
    Publication statusPublished - Feb 2004

    Keywords

    • MODE DOPPLER-ECHOCARDIOGRAPHY
    • RIGHT HEART CATHETERIZATION
    • FLOW PROPAGATION VELOCITY
    • CORONARY-ARTERY-DISEASE
    • DIASTOLIC FUNCTION
    • PROGNOSTIC IMPLICATIONS
    • DECELERATION TIME
    • COMPLICATIONS
    • PREVENTION
    • RELAXATION

    Cite this