Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction: A serial colorM-mode Doppler echocardiographic study

OBJECTIVE We sought to assess the prognostic value of left Ventricular (LV) filling patterns, as determined by mitral E-wave deceleration time (DT) an d color M-mode flow propagation velocity (Vp), on cardiac death and serial changes in LV volumes after a first myocardial infarction (MI). BACKGROUND Combined assessment of DT and Vp allows separation of the effect s of compliance and relaxation on LV filling, thereby allowing identificati on of pseudonormal filling. This may be valuable after MI, where abnormal L V filling is frequently present. METHODS Echocardiography was performed within 24 h, five days and one and t hree months after MI in 125 unselected consecutive patients. Normal filling was defined as DT 140 to 240 ms and Vp greater than or equal to 45 cm/s; i mpaired relaxation as DT greater than or equal to 240 ms; pseudonormal fill ing as DT 140 to 240 ms and Vp <45 cm/s; and restrictive filling as DT <140 ms. RESULTS Left ventricular filling was normal in 38 patients; impaired relaxa tion in 38; pseudonormal in 23; and restrictive in 26. End-systolic and end -diastolic volume indexes were significantly increased during the first thr ee months after MI in patients with pseudonormal or restrictive filling (37 +/- 15 vs. 47 +/- 14 ml/m(2), p < 0.0005 and 71 +/- 20 vs. 88 +/- 24 ml/m( 2), p < 0.0005, respectively). During a follow-up period of 12 +/- 7 months , 33 patients died. Mortality was significantly higher in patients with imp aired relaxation (p = 0.02), pseudonormal filling (p < 0.00005) and restric tive filling (p < 0.00005), compared with patients with normal filling. On Cox analysis, restrictive filling (p = 0.003), pseudonormal filling (p = 0. 006) and Killip class greater than or equal to II (p = 0.008) independently predicted cardiac death, compared with clinical and echocardiographic vari ables. CONCLUSIONS Pseudonormal or restrictive filling patterns we related to prog ressive LV dilation and predict cardiac death after a first hll. (C) 2000 b y the American College of Cardiology.