Prognostic implications of restrictive left ventricular filling in reperfused anterior acute myocardial infarction

OBJECTIVES We sought to assess the relative prognostic role of a restrictiv e left ventricular (LV) filling pattern after a first anterior acute myocar dial infarction (AMI) in patients treated with primary percutaneous translu minal coronary angioplasty (PTCA). BACKGROUND In thrombolized patients, a short Doppler-derived mitral deceler ation time (DT) of early filling is a powerful independent predictor of hea rt failure and death. However, it is still unknown whether the outcome of p atients with AMI with a short DT may be improved by a more aggressive treat ment. METHODS In 104 patients, two-dimensional and Doppler echocardiograms were o btained three days after the index AMI. Coronary angiography was performed in all patients one and six months after PTCA. The patients were classified into two groups according to the DT duration: group 1 (n = 34) with DT les s than or equal to 130 ms and group 2 (n = 70) with DT >130 ms. All patient s were followed-up for a mean (+/- SD) period of 32 +/- 10 months. RESULTS During the follow-up period, 14 patients (13%) were admitted to the hospital for congestive heart failure, and 9 patients (9%) died. All cardi ac deaths (n = 7) occurred in group 1. The survival rate at mean follow-up was 79% in group 1 and 97.2% in group 2 (p = 0.003). Multivariate Cox analy sis showed that only age and restrictive filling were independent predictor s of event-free survival. Furthermore, when survival with no cardiovascular events was analyzed, a short DT still emerged as the most powerful indepen dent predictor. CONCLUSIONS Patients with a restrictive LV filling pattern early after ante rior AMI have a poor clinical outcome, el en ii treated with primary PTCA. (J Am Coil Cardiol 2001;37:793-9) (C) 2001 by the American College of Cardi ology.