Noninvasive assessment of left ventricular filling pressure after acute myocardial infarction: a prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide.
BACKGROUND
Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this.


METHODS
Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years).


RESULTS
Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both).


CONCLUSIONS
The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.
Kruszewski
Kirsten
K
Department of Cardiology, Aberdeen Royal Infirmary/University of Aberdeen, Aberdeen, United Kingdom.
Scott
Anne E
AE
Barclay
Justin L
JL
Small
Gary R
GR
Croal
Bernard L
BL
Møller
Jacob E
JE
Oh
Jae K
JK
Hillis
Graham S
GS
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D015331:Cohort Studies; D016001:Confidence Intervals; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D017725:Ventricular Pressure / Q000502:physiology*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain