ABNORMAL FILLING PATTERN OF THE LEFT-VENTRICLE AND OUTCOME IN ACUTE MYOCARDIAL-INFARCTION

Background: The pattern of left ventricular filling by Doppler examina tion is frequently abnormal in myocardial infarction. Purpose: To rela te the different patterns of left ventricular filling to the clinical course of acute myocardial infarction. Patients and methods: We have s tudied 133 patients with acute myocardial infarction. Three different patterns of mitral flow were defined by Doppler examination: Type I ha s an E/A ratio lesser than one, and a deceleration time of the E wave longer than 180 ms; Type II has either an E/A ratio greater than one o r a deceleration time shorter than 180 ms; Type III has an E/A ratio g reater than 1.6 and a deceleration time shorter than 180 ms. We also d etermined the pulmonary wedge pressure through a pulmonary artery cath eter simultaneously with the Doppler examination on 22 occasions in 11 patients. Results: Mortality rate was 13%, 9% and 35% respectively in Type I, II and III (P=0.007). After logistic regression analysis of d eterminants of death, including all eight variables related with morta lity on an univariate analysis, only Killip class and the presence of a Type III pattern of the mitral flow remained significant (P=0.0004 a nd P=0.019 respectively). Pulmonary wedge pressure was 8.4+/-6.1 mmHg in Type I, 21.0+/-7.3 mmHg in Type II, and 22.4+/-7.1 mmHg in Type III (P=0.0017). Conclusion: Type III pattern of left ventricular filling is an independent predictor of death. Type I and II had no significant differences on prognosis. Type I is associated with a normal pulmonar y wedge pressure. (C) 1997 Elsevier Science Ireland Ltd.