HEART-FAILURE AFTER MYOCARDIAL-INFARCTION - THE IMPORTANCE OF DIASTOLIC DYSFUNCTION - A PROSPECTIVE CLINICAL AND ECHOCARDIOGRAPHIC STUDY

Clinical signs of heart failure based on predefined criteria were anal ysed in 217 survivors (< 75 years of age) of an acute myocardial infar ction (AMl). A Doppler investigation and M-mode echocardiography were performed 3-5 days after the index infarction. All patients were strat ified according to left ventricular end-diastolic diameter </greater t han or equal to 28 mm. m(-2) body surface area. Fractional shortening, E-point septal separation, Keren's echo-index based on left ventricul ar end-diastolic diameter, fractional shortening and E-point septal se paration were used as indices of systolic function, and the EIA ratio and isovolumic relaxation time as indices of diastolic function. Fifty -one per cent of the patients (n = 111) had heart failure. Left ventri cular end-diastolic diameter was <28 mm. m(-2) body surface area in 32 (29%) of the heart failure patients and in 44 (45%) of those without heart failure. An abnormal Keren's echo-index was found in 58 (52%) of the heart failure patients compared with 17 (18%) without heart failu re. The E/A ratio was lower (0.65 vs 0.77, P = 0.01) in heart failure patients with a normal left ventricular end-diastolic diameter compare d with patients without heart failure and a normal left ventricular en d-diastolic diameter. Infarct size, E-point septal separation, heart r ate and age were determinants of heart failure in multivariate analyse s with all patients included. Infarct size and the EIA ratio were dete rminants of heart failure in patients with a normal left ventricular e nd-diastolic diameter. Systolic dysfunction is a determinant of heart failure in the majority of patients after AMI, whereas diastolic dysfu nction is a determinant of heart failure in patients with a normal lef t ventricular end-diastolic diameter. Abnormal findings regarding left ventricular diameter and systolic function are present in 55% and 18% , respectively, of the patients without heart failure.