title: Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?
abstract: BACKGROUND
  Left ventricular ejection fraction (LVEF) has been considered a major determinant of early outcome in acute myocardial infarction (AMI). Myocardial performance index (MPI) has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF) specifically in patients with a first isolated ST-elevation AMI.
  
  
  METHODS
  Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class ≥ II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF.
  
  
  RESULTS
  Early in-hospital CHF occurred in 29 (31%) of patients. LVEF ≤ 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [95% CI 4.1 - 70.8]; p < 0.0001). MPI alone could not predict CHF in first ST-elevation AMI patients. Left atrial volume was not associated with early CHF in such patients.
  
  
  CONCLUSIONS
  For patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.
authors.affiliation: Cardiology Department, Escola Paulista de Medicina, Federal University of Sao Paulo, UNIFESP, Brazil.
authors.forename: Lilian P
authors.initials: LP
authors.lastname: Souza
authors.forename: Orlando
authors.initials: O
authors.lastname: Campos
authors.forename: Clovis A
authors.initials: CA
authors.lastname: Peres
authors.forename: Cristiano V
authors.initials: CV
authors.lastname: Machado
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D016275:Atrial Function / Q000502:physiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D018618:Echocardiography, Doppler, Color / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D016019:Survival Analysis; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*