Serial changes and prognostic implications of a Doppler-derived index of combined left ventricular systolic and diastolic myocardial performance in acute myocardial infarction

The purpose of this study was to investigate the serial changes and prognos tic value of a nongeometric Doppler-derived index of myocardial function th at combines systolic and diastolic time intervals of the left ventricle in acute myocardial infarction (AMI). The Doppler index was measured in 60 con secutive patients with AMI and in 30 patients admitted to hospital with sus pected but disproved AMI who served as controls. The patients were studied at days 1, 5, 90, and 360 after arrival in the coronary care unit. The inde x was defined as the sum of isovolumetric contraction time, and isovolumetr ic relaxation time divided by ejection time was measured from mitral inflow and left ventricular outflow Doppler velocity profiles. The index was sign ificantly higher in patients with AMI than in control subjects at days 1 an d 360 (day 1, 0.58 +/- 0.09 vs 0.41 +/- 0.08, p < 0.0001; day 360, 0.50 +/- 0.09 vs 0.39 +/- 0.07, p < 0.01, respectively). The index decreased signif icantly in patients with AMI during follow-up (p < 0.01). The index was sig nificantly higher in patients who developed congestive heart failure or die d compared with survivors who were free of congestive heart failure (day 1, 0.63 +/- 0.10 vs 0.53 +/- 0.10, p < 0.01; day 360, 0.56 +/- 0.08 vs 0.48 /- 0.10, p < 0.01, respectively). During 20.2 +/- 8.5 months' follow-up, 10 patients died of cardiac causes and 13 developed congestive heart failure. Univariate analyses demonstrated that the Doppler index greater than or eq ual to 0.60 (chi-square 8.3, p < 0.0001), deceleration time less than or eq ual to 140 ms (chi-square 8.5, p < 0.0001), ejection fraction less than or equal to 0.40% (chi-square 3.3, p < 0.005), anterior wall AMI (chi-square 3 .2, p < 0.01), and age (chi-square 1.06/year increase, p < 0.01) were signi ficant predictors of outcome. Multivariate stepwise analysis showed that th e index less than or equal to 0.60 (chi-square 3.4, p < 0.05), deceleration time less than or equal to 140 ms (chi-square 4.2, p < 0.02), and age (chi -square 1.06/year increase, p < 0.02) were independent predictors of outcom e. The Doppler index reflects severity of left ventricular function and has incremental prognostic value in patients with AMI. (C) 2000 by Excerpta Me dico, Inc.