E/e' in relation to outcomes in ST‐elevation myocardial infarction

Abstract

Background: Myocardial infarction (MI) is a high-risk condition especially when filling pressure is raised, and earlier reports have suggested that E/e' is associated with poor outcome. However, whether E/e' predicts risk better than LVEF, which is the current standard of practice, is not known. We investigated this question in the largest and most rigorous study of MI patients so far. Methods and Results:We studied 660 patients with ST-elevation MI (STEMI) treated with primary percutaneous coronary intervention and related E/e' to short-term mortality (in-hospital death), as well as long-term events at 2 years comprising (a) a composite of MI, stroke, heart failure, and death, and (b) death alone. Short-term models were adjusted for age, sex, and LVEF. Long-term models were adjusted for age, sex, diabetes, revascularization procedure, history of MI, hypertension, renal function, drugs on discharge, and LVEF. Elevated E/e'> 15 indicated higher risk of short-term events (n = 19:7.0% (95% confidence interval 3.4-10.8%) vs. 1.0% (0.3 -2.3%); adjusted odds ratio 3.7 (1.3-10.5)). While elevated E/e' was also associated with long-term outcomes (n = 103 composite events: 15.9% (11.9% -21.4%) vs 6.8% (5.2% -8.7%), P < .001; n = 38 death events: 6.0% (3.9% -9.5%) vs 2.0% (1.3% -3.2%), P = .001), E/e' was rendered nonsignificant for long-term outcomes by multivariable adjustment (p = ns for both). LVEF, on the contrary, was a highly significant predictor in the adjusted long-term model. Conclusion:E/e' is associated with poor outcome in STEMI, but LVEF is a stronger predictor of long-term risk. K E Y W O R D S E/e', echocardiography, filling pressure, myocardial infarction S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section.

The long-term prognostic value of E/e’ in patients with ST segment elevation myocardial infarction

“…Moreover, we independently assessed the risk factors for cardiac death as one of the components of MACEs, while several studies have focused on all-cause mortality. 1 , 6 , 27 An abnormal E/e’ ratio has been shown to be a powerful risk factor for all-cause death across studies. According to Iwahashi et al, an E/e’ ratio ≥15 observed two weeks after a STEMI event was shown as the strongest predictive factor of cardiac death and a strong prognostic implication of an abnormal E/e’ ratio compared to the LVEF, which is consistent with our study, emphasizing the role of E/e’ ratio as a powerful prognostic factor for adverse outcomes.…”

“…Despite technical advances in the field of coronary intervention, the development of major adverse cardiac events (MACEs) after acute myocardial infarction (MI) remains a major cause of mortality and morbidity worldwide. 1 , 2 Effective risk stratification is crucial for high-risk patients to decide on early aggressive management, which may improve the overall clinical outcomes. 3 Prior studies have suggested various predictors of MACEs in patients with MI, including high-scoring systems (SYNTAX, TIMI, and GRACE), infarct size, and certain echocardiographic parameters.…”

“… 3 Prior studies have suggested various predictors of MACEs in patients with MI, including high-scoring systems (SYNTAX, TIMI, and GRACE), infarct size, and certain echocardiographic parameters. 1 , 4 MI induces direct damage and necrosis of the myocytes, leading to the impairment of cardiac function. 5 However, several data on patients with ST segment elevation MI (STEMI) alone exist, resulting from a high percentage of critical initial conditions.…”

“… 8 , 9 Furthermore, predicting clinical outcomes in STEMI applying left ventricular ejection fraction (LVEF) and left ventricular (LV) diastolic function still remains controversial. 1 The role of LV diastolic function, evaluated by the E/e’ ratio, has emerged as an important predictor of outcome in patients with STEMI since LV diastolic dysfunction precedesLV systolic dysfunction after myocardial ischemia occurs. 10 , 11 Nevertheless, some problems with the E/e’ ratio in the STEMI field remain.…”

“…For example, there remains a need for data with a longer follow-up period regarding the association with cardiac deaths and the clinical implications of follow-up echocardiographic parameters. 1 , 6 , 12 Hence, we aimed to investigate the clinical implications of the E/e’ ratio with long-term MACEs in patients with ST-elevation myocardial infarction (STEMI).…”