Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction

Background Left ventricular (IV) diastolic dysfunction contributes to signs and Symptoms of clinical heart failure and may be related to prognosis in heart diseases. LV diastolic dysfunction is reported to be present in acute myocardial infarction (MI); however, little is known about the time course of changes in LV diastolic function and its:relation to prognosis after ac ute MI. Methods and Results Two-dimensional and Doppler echocardiographic examinati ons were performed in 58 consecutive patients with first acute MI. The pati ents were studied serially within 1 hour and at days 5, 90, and 360 after a rrival to the coronary care unit. LV diastolic Function was assessed by Dop pler measurements of transmitral and pulmonary venous flow. On the basis of mitral Inflow, patients with MI were stratified at baseline to 3 IV diasto lic Filling patterns: normal, impaired relaxation, or pseudonormal/restrict ive. Patients with MI were observed for development of congestive heart fai lure (Killip class >1) during hospitalization and for death during 1-year f ollow-up, and these complications were related to LV diastolic function. LV diastolic dysfunction was present in the very early phase of acute MI, wit h signs of impaired relaxation or restrictive LV Filling dynamics in 38% an d 24% of the patients, respectively, whereas 38% had normal LV filling char acteristics. Impaired relaxation of the IV was most pronounced and found in 60% after 1-year follow-up. In-hospital congestive heart failure (Killip c lass >1) was found in 50% of the patients with initial impaired LV relaxati on and in 71% of the patients with initially pseudonormal or restrictive LV filling dynamics, whereas patients with normal LV filling were free of hea rt failure. Patients with initial impaired relaxation and restrictive LV fi lling dynamics demonstrated a significant IV dilation during 1-year Follow- up. Patients with initial pseudonormal/restrictive LV filling pattern were more frequently readmitted to the hospital for heart failure and had signif icant higher New York Heart Association class score compared with patients with normal or impaired relaxation during follow-up. Cardiac death was (n = 6) only observed in patients with pseudonormal or restrictive LV filling p attern. In a multivariate stepwise regression analysis, mitral E decelerati on time less than or equal to 140 ms and age were identified as independent variables related to development of in-hospital congestive heart failure a nd cardiac death during 12 months of follow-up. Conclusions LV diastolic dysfunction is present in the very early phase of MI. LV remodeling and development of in-hospital congestive heart failure a ppear in patients with very early signs of LV diastolic bysfunction. Furthe rmore, mitral E deceleration time less than or equal to 140 ms best identif ied patients at risk of development of in-hospital congestive heart failure and cardiac death after MI.