Evaluation and prognostic significance of left ventricular diastolic function assessed by Doppler echocardiography in the early phase of a first acute myocardial infarction.

Abstract

To study the prognostic significance of left ventricular diastolic function evaluated by transmitral and pulmonary venous flow velocities obtained in the early phase of a first acute myocardial infarction in relation to later development of congestive heart failure. Pulsed Doppler echocardiography of transmitral and pulmonary venous flow was assessed in 65 consecutive patients with a first myocardial infarction within 1 h of arrival in the coronary care unit. A univariate regression analysis identified age, left ventricular ejection fraction < or = 45%, mitral E deceleration time < or = 130 ms, E/A ratio > 1.5, peak pulmonary venous atrial flow velocity > or = 30 cm.s-1 and a difference between mitral and pulmonary venous atrial flow duration < 0 ms as variables significantly related to the development of congestive heart failure. However, in a multivariate analysis only mitral E deceleration time < or = 130 ms and age were significant independent variables related to the development of congestive heart failure during the first week following a first acute myocardial infarction. Assessment of left ventricular diastolic function complements measurements of systolic function in the evaluation of cardiac function, and mitral deceleration < or = 130 ms best identifies patients at risk of development of congestive heart failure following acute myocardial infarction.