Doppler Transmitral Flow Pattern Is an Independent Prognostic Factor in Acute Myocardial Infarction

Garcia-Rubira, Juan Carlos; García-Martínez, Juan T.; Hidalgo, Ricardo; Gómez-Barrado, José J.; Revuelta, M. R. Rodriguez; Banos, J. Rodriguez; Cruz, Jurandir Ferreira da

doi:10.1159/000177330

Cited by 10 publications

(5 citation statements)

References 10 publications

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“…The data of patients with RPLVF come mainly from patients with dilated [1, 3, 20, 21]and ischemic cardiomyopathy [6, 22]. The poor prognosis of this group of patients is well known [1, 4, 12, 20]and is similar to that of the patients in group 2 in the present study when compared with echocardiographic controls.…”

Section: Discussionsupporting

confidence: 77%

“…A restrictive pattern of left ventricular filling (RPLVF) and its prognostic implications have been extensively studied in patients with impaired left ventricular systolic function and ischemic heart disease [1, 2, 3, 4, 5, 6]. The presence of RPLVF is associated with elevated left ventricular filling pressures in patients with impaired systolic function [7, 8, 9]and identifies a group of patients with worst symptoms and poor prognosis [3, 4].…”

Section: Introductionmentioning

confidence: 99%

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Restrictive Left Ventricular Filling Pattern with Preserved Systolic Function Assessed by Doppler Echocardiography: Clinical, Echocardiographic and Prognostic Implications

Boccalandro

Loghin²,

Darwood

et al. 2002

Cardiology

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From an echocardiographic laboratory database, echocardiographic characteristics of clinical and cardiovascular mortality were compared in patients with restrictive pattern of left ventricular filling (RPLVF) and left ventricular ejection fraction (LVEF) >50% (n = 36), with patients with RPLVF and LVEF <50% (n = 120) and echocardiographic controls (n = 160). Preserved LVEF was found in 21% of the patients with RPLVF. Mortality in patients with RPLVF was worst compared with echocardiographic controls regardless of their underlying LVEF after 2.7 ± 1 years of follow-up. Patients with RPLVF had distinctive predictors of cardiovascular death, with clinical and echocardiographic characteristics according to their LVEF.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Restrictive Left Ventricular Filling Pattern with Preserved Systolic Function Assessed by Doppler Echocardiography: Clinical, Echocardiographic and Prognostic Implications

Boccalandro

Loghin²,

Darwood

et al. 2002

Cardiology

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“…54 -58,61-63 A restrictive filling pattern seems to have the same prognostic importance in STand non-ST-segment elevation AMI 56 and in patients treated with thrombolysis or primary angioplasty. 55,57 Although the results of those studies have been strikingly similar, many have been limited by small populations and few events. However, in 799 patients with assessment of LV filling within 6 days of AMI, DT Ͻ140 ms was a predictor of all-cause mortality, with a hazard ratio of 2.1 (95% CI, 1.5 to 3.1), after adjustment for various clinical variables including in-hospital heart failure and LV systolic function.…”

Section: Relation Between LV Filling Pattern/la Size and Prognosis Afmentioning

confidence: 92%

Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction

et al. 2006

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A cute myocardial infarction (AMI) is characterized by regional myocardial damage that may lead to systolic and diastolic dysfunction with a subsequent risk of left ventricular (LV) remodeling, local and systemic neurohormonal activation, and vascular dysfunction. The pathophysiology and prognosis of LV systolic dysfunction after AMI have been the focus of research for several decades. Insights from these studies have led to several therapeutic interventions that improve outcome. In addition to depressed systolic function, clinical or radiographic evidence of heart failure is a consistent and powerful predictor of outcome in patients after AMI. 1 Pulmonary congestion after infarction reflects raised LV filling pressures but is frequently seen after what appears to be only minor myocardial damage. 2 The pathophysiological mechanism for this is incompletely understood but may involve impaired active relaxation of the myocardium and increased LV chamber stiffness and hence abnormalities in diastolic function. If these are to be determined directly, cardiac catheterization with assessment of pressurevolume relationships with the use of high-fidelity micromanometer catheters is required. This highly specialized approach is not suitable for daily clinical practice. Likewise, although direct measurements of right heart or LV end-diastolic pressure are important predictors of adverse outcome after AMI in selected populations, 3,4 the risk of complications precludes routine use of indwelling catheters in all patients. There has therefore been considerable interest in using noninvasive estimates of diastolic function, particularly Doppler echocardiographic assessment of LV filling dynamics and, more recently, the volume of the left atrium (LA), to predict outcome in patients with AMI.The objective of this review is to summarize the current understanding of abnormal LV filling in the early phase after AMI with focus on the complementary prognostic information that may be gained by assessment of LV filling dynamics and LA volume with the use of 2-dimensional and Doppler echocardiography. Doppler Echocardiographic Assessment of Diastolic FunctionAfter an AMI, myocardial ischemia, cell necrosis, microvascular dysfunction, and regional wall motion abnormalities will influence the rate of active relaxation. In addition, interstitial edema, fibrocellular infiltration, and scar formation will directly affect LV chamber stiffness. Thus, abnormalities in LV filling are common in this setting. Spectral Pulsed-Wave Doppler EchocardiographyThe pulsed-wave Doppler technique allows assessment of flow velocities (Ͻ2 m/s) at a distinct spatial position, making the technique suitable for assessment of changes in inflow velocities across the mitral valve during diastole. With mitral valve opening, the early inflow velocity will be determined largely by ventricular suction and the pressure gradient between the LA and LV. [5][6][7] This is followed by a steady decrease in inflow velocity, with a normal duration of 140 to 240 ms (early mitral ...

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“…RPLVF in combination with depressed left ventricular systolic function is associated with advanced organic heart disease [3], severely impaired left ventricular function [11], higher left-sided filling pressures [12], worse symptoms of congestive heart failure [13, 14]and worse survival [1, 8, 15, 16]for idiopathic dilated [1, 7, 16, 17]and ischemic cardiomyopathy [11, 18]. Despite the ominous prognostic implications of RPLVF, the predictors of cardiovascular death that might help to identify the patients with the highest risk in this population have not been previously investigated.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Cardiovascular Death in Patients with a Left Ventricular Restrictive Filling Pattern of the Mitral Inflow

Boccalandro¹,

Loghin²,

Seung-Ho³

et al. 2004

Cardiology

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The survival, clinical and echocardiographic variables and the predictors of cardiovascular death were determined for a group of 168 patients (mean age 63 ± 13 years; 65 females; mean left ventricular ejection fraction 32 ± 10%) with restrictive filling of the left ventricle and depressed systolic function after a mean follow-up period of 2.7 ± 1 years. Shorter deceleration time (DT) of the mitral inflow was the only variable significantly different between survivors and nonsurvivors (p < 0.05) and the only predictor of death found by multivariate logistic regression analysis (odds ratio 2.2, 95% confidence interval 1.7–3.6). In this patient population, a DT of the early wave of the mitral inflow <140 ms identified the patients with the highest risk of cardiac death. DT is a practical echocardiographic parameter for risk stratification of patients with significant left ventricular systolic dysfunction and restrictive filling of the left ventricle.

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Doppler Transmitral Flow Pattern Is an Independent Prognostic Factor in Acute Myocardial Infarction

Cited by 10 publications

References 10 publications

Restrictive Left Ventricular Filling Pattern with Preserved Systolic Function Assessed by Doppler Echocardiography: Clinical, Echocardiographic and Prognostic Implications

Restrictive Left Ventricular Filling Pattern with Preserved Systolic Function Assessed by Doppler Echocardiography: Clinical, Echocardiographic and Prognostic Implications

Prognostic Importance of Diastolic Function and Filling Pressure in Patients With Acute Myocardial Infarction

Predictors of Cardiovascular Death in Patients with a Left Ventricular Restrictive Filling Pattern of the Mitral Inflow

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