Impacts of Diastolic Function on Clinical Outcomes in Young Patients with Acute Myocardial Infarction

Abstract

Background/Aims: The impact of left ventricular (LV) diastolic function and filling pressure on clinical outcomes in young patients with acute myocardial infarction (AMI) has been poorly studied. Therefore, the aim of this study was to investigate the impact of LV diastolic function and LV filling pressure on major adverse cardiac events (MACEs) in young patients with AMI. Methods: A total of 200 young patients (males < 45 year, females < 55 year) with AMI were divided into two groups according to the diastolic function; normal (n = 46, 39.5 ± 5.3 years) versus abnormal (n = 154, 43.5 ± 5.1 years). Results: Despite regional wall motion abnormalities, normal LV diastolic function was not uncommon in young AMI patients (23.0%). During the 40 months of clinical follow-up, MACEs developed in 26 patients (13.0%); 14 re-percutaneous coronary intervention (7.0%), 8 recurrent MI (4.0%), and 4 deaths (2.0%). MACEs did not differ between the normal and abnormal diastolic function group (13.6% vs. 10.9%, p = 0.810), but MACEs were significantly higher in the high LV filling pressure group than the normal LV filling pressure group (36.8% vs. 10.5%, p < 0.001). On multivariate analysis, high LV filling pressure was an independent predictor of MACEs (hazard ratio 3.022, 95% confidence interval 1.200-7.612, p = 0.019). Conclusions: This study suggested that measurement of the LV filling pressure (E/e' ratio) would be useful in the risk stratification of young patients with AMI. However, it would be necessary to monitor this category of patient more carefully.

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

“… 7 Several diastolic function parameters that were introduced and used for predicting the clinical outcome in acute MI include the LV filling pattern, deceleration time, LA volume index, Tei index, and E/e’ ratio. 12 , 19 , 20 According to the latest recommendations, the E/e’ ratio and mitral annular early diastolic velocity (e’) using pulse-wave Doppler are strongly recommended for the assessment of LV diastolic dysfunction. 21 The early mitral inflow velocity increases while e’ decreases under elevated LV filling pressure.…”

“… 23 , 24 Among the established prognostic factors, several studies have demonstrated the ascendancy of the E/e’ ratio over other variables. 6 , 20 , 25 However, these studies were conducted in patients with acute MI, in which reperfusion therapy timing was different. To reduce such bias, we only included patients with STEMI who underwent coronary intervention within 12 hours of hospital arrival.…”