Abnormal filling pattern of the left ventricle and outcome in acute myocardial infarction.
BACKGROUND
The pattern of left ventricular filling by Doppler examination is frequently abnormal in myocardial infarction.


OBJECTIVE
To relate the different patterns of left ventricular filling to the clinical course of acute myocardial infarction.


METHODS
We have studied 133 patients with acute myocardial infarction. Three different patterns of mitral flow were defined by Doppler examination: Type I has 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 or a deceleration time shorter than 180 ms; Type III has an E/A ratio greater than 1.6 and a deceleration time shorter than 180 ms. We also determined the pulmonary wedge pressure through a pulmonary artery catheter 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 determinants of death, including all eight variables related with mortality on an univariate analysis, only Killip class and the presence of a Type III pattern of the mitral flow remained significant (P=0.0004 and 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).


CONCLUSIONS
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 pulmonary wedge pressure.
García-Rubira
J C
JC
Unidad Coronaria, Hospital Universitario Virgen Macarena, Sevilla, España.
Molano
F
F
Espina
A
A
Calvo
R
R
González-Valday
M
M
García-Martínez
J T
JT
Cruz
J M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D015588:Observer Variation; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D015912:Thrombolytic Therapy; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging