Prediction of heart failure post myocardial infarction: comparison of ejection fraction, transmitral filling parameters, and the index of myocardial performance.
Following an acute myocardial infarction (MI), the development of congestive heart failure (CHF) has been associated with a reduced ejection fraction (EF), pseudonormal or restrictive diastolic filling, and an increased index of myocardial performance (IMP).


OBJECTIVE
To determine the comparative predictive value of EF, transmitral filling parameters, and IMP for the development of CHF following a first MI.


METHODS
A retrospective analysis of consecutive echocardiographic and Doppler studies in patients admitted for their first acute MI from the years 1988 through 1992. We studied 109 patients following their first MI with two-dimensional and Doppler within 24 hours of MI. We divided patients into those who developed CHF within 15 days (43 patients) and without CHF (66 patients).


RESULTS
Patients who developed CHF had greater LV dilatation, lower EF (27.7%+/- 10.2% vs 45.6%+/- 13.2%, P < 0.001), higher E/A, shorter deceleration times (DCT; 157 +/- 69 msec vs 248 +/- 105 msec, P < 0.001), and increased IMP. Utilizing multiple logistic regression, EF (strongest predictor), DCT, and IMP were predictive of CHF. Nineteen patients in the no CHF group developed late CHF and had lower EFs (30.5%+/- 13.1% vs 50.5%+/- 9.8%, P < 0.001), higher E/A and shorter DCTs (161 +/- 39 msec vs 283 +/- 103 msec, P < 0.001). EF, DCT, and E/A were predictive of late CHF in patients without initial CHF. For patients admitted with a first MI, the EF, DCT, and to a lesser extent IMP predicted who would ultimately develop CHF. An EF < 40% or a DCT < 200 msec correctly predicted CHF in 60 of 62 patients.


CONCLUSIONS
We conclude that the early and ultimate development of CHF following a first MI were associated with an moderately reduced EF < 40%, pseudonormal diastolic filling indices, and an increased IMP.
Lavine
Steven J
SJ
Department of Medicine, Cardiovascular Center, Shands Hospital/Jacksonville, University of Florida, Jacksonville, Florida 32209, USA. steven.lvine@jax.ufl.edu
D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D016277:Ventricular Function, Left