Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction - Prognostic and clinical implications

OBJECTIVES To determine the ability of the ratio of peak E-wave velocity to flow propagation velocity (E/Vp) measured with color M-mode Doppler echoca rdiography to predict in-hospital heart failure and cardiac mortality in an unselected consecutive population with first myocardial infarction (MI). BACKGROUND Several experimental studies indicate color M-mode echocardiogra phy to be a valuable tool in the evaluation of diastolic function, but data regarding: the clinical value are lacking. METHODS Echocardiography was performed within 24 h of arrival at the corona ry care unit in 110 consecutive patients with first MI. Highest Killip clas s was determined during hospitalization. Patients were divided into groups according to E/Vp <1.5 and greater than or equal to 1.5. RESULTS During hospitalization 53 patients were in Killip class greater tha n or equal to II. In patients with E/Vp greater than or equal to 1.5, Killi p class was significantly higher compared with patients with E/Vp <1.5 (p < 0.0001). Multivariate logistic regression analysis identified E/Vp greater than or equal to 1.5 to be the single best predictor of in-hospital clinic al heart failure when compared with ape, heart rate, E-wave deceleration ti me (Dt), left ventricular (LV) ejection fraction, wall motion index, enzyma tic infarct size and Q-wave MI. At day 35 survival in patients with E/Vp <1 .5 was 98%, while for patients with E/Vp greater than or equal to 1.5, it w as 58% (p < 0.0001). Cox proportional hazards model identified Dt <140 ms, E/Vp greater than or equal to 1.5 and age to be independent predictors of c ardiac death, with Dt <140 ms being superior to age and E/Vp. CONCLUSIONS In the acute phase of MI, E/Vp greater than or equal to 1.5 mea sured with color M-mode echocardiography is a strong predictor of in-hospit al heart failure. Furthermore, E/Vp is superior to systolic measurements in predicting 35 day survival although Dt <140 ms is the most powerful predic tor of cardiac death. (J Am Coll Cardiol 2000;35:363-70) (C) 2000 by the Am erican College of Cardiology.