The clinical value of mitral A-wave deceleration time in the prediction of a long-term adverse outcome in patients with myocardial infarction.
BACKGROUND
Mitral A-wave deceleration time (Adt) is a promising Doppler parameter for the evaluation of left ventricular (LV) diastolic function. The aim of the present study was to investigate the long-term prognostic value of Adt in relation to the development of heart failure and cardiac death in the setting of the first acute myocardial infarction (MI).


METHODS
Conventional Doppler echocardiographic study and Adt measurements were performed in 105 patients (age 60 +/- 10 years, 77 men) 8.07 +/- 0.96 days post MI. Patients were divided into three groups according to Adt duration: group 1 with Adt > or =70 ms, group 2 with 70 ms < Adt <115 ms, and group 3 with Adt > or =115 ms.


RESULTS
Patients of groups 1 (Adt: 64 +/- 5 ms, n=11) and 3 (Adt: 123 +/- 8 ms, n=38) presented characteristics of restrictive physiology or impaired relaxation, respectively, while patients of group 2 (Adt: 92 +/- 9 ms, n=56) had near to normal LV filling characteristics. Patients were followed up for a mean of 44.7 months. Heart failure was found in 4 patients (36%) in group 1 and 6 (16%) in group 3, whereas the patients in group 2 were free of heart failure. Cardiac death occurred in 4 patients (36%) in group 1, 3 (7.9%) in group 3 and 2 (3.6%) in group 2. Kaplan-Meier survival curves indicated that patients with Adt < or =70 ms or Adt > or =115 ms had more frequent cardiac events and a significantly shorter event-free survival period in comparison with those with 70 ms < Adt < 115 ms (p = 0.0017). Cox analysis showed that Adt < or =70 ms (p = 0.002), Adt > or =115 ms (p = 0.02), restrictive LV filling pattern (p = 0.003), anterior wall MI (p = 0.02), ejection fraction (p = 0.03), age (p = 0.04), and treatment with angiotensin converting enzyme inhibitors (p = 0.009) were independent predictors of outcome.


CONCLUSIONS
Adt appears to be a strong and independent predictor of heart failure or cardiac death following a MI. A shortened Adt < or =70 ms is associated with higher rates of both cardiac death and heart failure, while a prolonged Adt > or =115 ms is associated with heart failure only.
Nearchou
Nearchos S
NS
Cardiology Department, Hellenic Red Cross Hospital, Constantopoulio Agia Olga General Hospital, Athens, Greece.
Karatzis
Emmanouil N
EN
Nikolaou
Nikolaos I
NI
Papadakis
John E
JE
Flessa
Constantina D
CD
Giannakopoulou
Anna T
AT
Tsitsirikos
Marios D
MD
Tsakiris
Alexandros K
AK
D018572:Disease-Free Survival; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*