[Prognostic value of a model using restricted left ventricular filling for prediction of developing heart failure after myocardial infarction].
The prognostic significance of restrictive pattern (RP) of mitral flow in myocardial infarction (MI) has yet not been defined. The aim of the study was to assess the relationship of a RP in MI patients at discharge with the development of left ventricular (LV) dilatation and clinical symptoms of heart failure (HF) after one year.


METHODS
2D and Doppler Echocardiography was performed on 88 patients (mean age 53.8 +/- 11) at discharge after their first MI and then one year after that MI. Patients were classified according to Doppler examination at discharge into 2 groups: Group I-RP (n = 9) with peak E to A ratio E/A > or = 2 or E/A > or = 1.5 and deceleration time DT < or = 140 ms, Group II--non-restrictive pattern nRP (n = 79). In predicting the development of HF the following variables were analysed using Cox proportional hazard model: MI location and extension (Inf, Ant, non-Q, Q-wave), reperfusion defined by non-invasive features (R/+/, R/-/), Killip-Kimball class (K-K), end-diastolic volume index (EDVI), end-systolic volume index (ESVI), ejection fraction (EF), wall motion score index (WMSI) and restrictive pattern of mitral flow presence (RP).


RESULTS
HF developed in 23 patients: 8 pts were in RP-group (89%), while 15 pts were in nRP-group (19%) (rr = 4.68 p < or = 0.001). In the univariate Cox analysis, the following variables were associated with higher incidence of HF: Q-MI (rr = 5.66 p < or = 0.05), R- (rr = 4.96 p < or = 0.001), K-K > or = II (rr = 3.13 p < or = 0.01), EDVI > or = 80 ml/m2 (rr = 5.85 p < or = 0.001), ESVI > or = 40 ml/m2 (rr = 4.07 p < or = 0.001), WMSI > or = 1.4 (rr = 2.79 p < or = 0.01) and RP (rr = 4.6 p < or = 0.001). However, the multivariate Cox analysis revealed only three significant independent predictors of HF: EDVI > or = 80 ml/m2 (rr = 6.27 p < or = 0.001), R- (rr = 4.74 p < or = 0.01) and RP (rr = 3.2 p < or = 0.05). The cumulative predictive power of RP in connection with the selected parameters (RP + K-K > or = II, RP + EF < or = 45%, RP + WMSI > or = 1.4) was higher for RP + K-K > or = II (rr = 4.61 p < or = 0.001) and especially for RP + WMSI > or = 1.4 (rr = 5.06 p < or = 0.001).


CONCLUSIONS
The restrictive pattern of LV filling in MI pts at discharge is an independent predictor of heart failure development. The assessment of both diastolic and systolic LV functions parameters increases prediction power.
Brzeznińska
Barbara
B
Oddział Kardiologiczny Dolnoślaskiego Szpitala Specjalistycznego im. T. Marciniaka, 42-420 Wrocław, ul. Traugutta 116. Barbara.1656177@pharmanet.com.pl
Łoboz-Grudzień
Krystyna
K
Kowalska
Alicja
A
Sokalski
Leszek
L
D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume; D013599:Systole