Serial Doppler echocardiographic assessment of diastolic dysfunction during acute myocardial infarction.
OBJECTIVE
We performed serial Doppler echocardiography in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) to describe the temporal changes in Doppler parameters following STEMI.


BACKGROUND
Data on comprehensive Doppler assessment of diastolic dysfunction following STEMI, incorporating tissue Doppler imaging (TDI), are lacking. Severe diastolic dysfunction in stable patients usually manifests as a restrictive mitral filling pattern (RFP), reduced TDI-derived annular velocities (E'), and elevated E/E' ratios >15.


METHODS
Twenty-eight patients (19 males, mean age 60 ± 10 years) with a first-ever STEMI who underwent PCI were prospectively assessed with echocardiography and invasive left ventricular end-diastolic pressure (LVEDP) measurements prior to PCI. Repeat echocardiograms were performed at day 3 and 12 months.


RESULTS
During STEMI: (i) LVEDP was significantly elevated but decreased post revascularization (26.1 ± 6.2 vs. 20.8 ± 5.2 mmHg, P = 0.002); (ii) the predominant mitral inflow pattern was an abnormal relaxation pattern (n = 14 [50%]), whereas restrictive filling pattern was only observed in seven (25%) patients; (iii) E' velocities were only modestly reduced (septal E' 7.4 ± 2.2 cm/sec, lateral E' 9.6 ± 2.2 cm/sec), and (iv) a septal E/E'ratio >15 seen in only one patient, whereas all other patients had an E/E' ratio of 8-15. Serial TDI showed that E'velocity decreased at day 3 (septal E' 7.4 ± 2.1 cm/sec vs. 5.9 ± 1.6 cm/sec, P = 0.002) and remained reduced at 1 year follow-up, suggesting persistence of diastolic dysfunction.


CONCLUSIONS
During STEMI, contrary to findings in stable patients, the predominant Doppler manifestation of the severe diastolic dysfunction and elevated LVEDP was an abnormal relaxation mitral inflow pattern accompanied by E/E' ratios of 8-15. Serial Doppler assessment suggests incomplete diastolic recovery following STEMI.
Department of Cardiology, Westmead Hospital, Westmead, Sydney, Australia.
Sandhir B
SB
Prasad
Valerie
V
See
Timothy
T
Tan
Paula
P
Brown
Tania
T
McKay
Pramesh
P
Kovoor
Liza
L
Thomas
D003937:Diagnosis, Differential; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology