PROGNOSTIC IMPLICATIONS OF RESTRICTIVE LEFT-VENTRICULAR FILLING IN ACUTE MYOCARDIAL-INFARCTION - A SERIAL DOPPLER-ECHOCARDIOGRAPHIC STUDY

Objectives. This study was designed to evaluate the relative prognosti c significance of restrictive left ventricular (LV) filling after acut e myocardial infarction. Background. Data regarding the contribution o f diastolic dysfunction to prognosis after myocardial infarction are l imited, and the additional value over the assessment of systolic dysfu nction is not known. Methods. Serial Doppler echocardiography was perf ormed in 95 patients on days 1, 3 and 7 and 3 months after acute myoca rdial infarction. Patients were classified into two groups: a restrict ive group (n = 12) with a peak velocity of early diastolic filling wav e (E)/peak velocity of late filling wave (A) ratio greater than or equ al to 2 or between 1 and 2 and a deceleration time (DT) less than or e qual to 140 ms during at least one echocardiographic study; and a nonr estrictive group (n = 83) with an E/A ratio less than or equal to 1 or between 1 and 2 and a DT >140 ms at all examinations. Results. Cardia c death occurred in 10 patients during a mean follow-up interval of 32 +/- 17 months. The survival rate at 1 year was 100% in the nonrestric tive group and only 50% in the restrictive group. After 1 year there w as a continuing divergence of mortality, resulting in a 3-year surviva l rate of 100% and 22%, respectively. Univariate Cox analysis revealed that restrictive LV filling, wall motion score index, ejection fracti on and end-systolic and end diastolic volume indexes, as well as peak creatine kinase, peak MB fraction and heart failure during the hospita l course were significant predictors of cardiac death, although restri ctive filling was the single best predictor (p < 0.0001), Multivariate analysis showed that restrictive filling adds prognostic information to clinical and echocardiographic variables of systolic dysfunction. C onclusions. Restrictive LV filling after acute myocardial infarction i s the single best predictor of cardiac death and adds significantly to clinical and echocardiographic markers of systolic dysfunction. (C) 1 997 by the American College of Cardiology.