title: E/e' two weeks after onset is a powerful predictor of cardiac death and heart failure in patients with a first-time ST elevation acute myocardial infarction.
abstract: BACKGROUND
  Early transmitral flow velocity (E) divided by early diastolic velocity of the mitral valve annulus (e') is referred to as the E/e' ratio, a variable that strongly correlates with mean left ventricular filling pressure. E/e' obtained at acute phase has been reported as useful in predicting prognosis in patients with acute myocardial infarctions. The aim of this study was to evaluate the clinical utility of echocardiographic indices obtained 2 weeks after the onset of a first ST-segment elevation myocardial infarction as predictors of outcomes.
  
  
  METHODS
  Echocardiography was performed and blood samples were obtained from 301 consecutive patients 2 weeks after the onset of a first ST-segment elevation myocardial infarction. All patients underwent primary percutaneous coronary intervention <12 hours after symptom onset and were followed for 51.7 ± 19.0 months. The primary end point was cardiac death or readmission for heart failure.
  
  
  RESULTS
  During follow-up, cardiac death occurred in 10 patients, and heart failure developed in 35. On univariate analysis, age > 75 years, plasma brain natriuretic peptide > 180 pg/mL, early diastolic/late diastolic wave velocity of mitral inflow > 1.0, mitral inflow deceleration time < 140 msec, and E/e' > 15 were associated with the primary end points. Multivariate analysis showed that E/e' > 15 was the strongest predictor (hazard ratio, 3.702; 95% confidence interval, 1.895-7.391; P = .0001), followed by early diastolic/late diastolic wave velocity of mitral inflow > 1.0 (hazard ratio, 3.053; 95% confidence interval, 1.584-6.125; P = .008). Predictive accuracy was further enhanced by combing E/e' > 15 and early diastolic/late diastolic wave velocity of mitral inflow > 1.0 (hazard ratio, 7.373; 95% confidence interval, 3.529-16.528; P < .0001).
  
  
  CONCLUSIONS
  E/e' > 15 obtained 2 weeks after onset is the strongest predictor of cardiac death and readmission for heart failure after a reperfused first ST-segment elevation myocardial infarction. The predictive value of E/e' at 2 weeks is further enhanced by combining this variable with mitral inflow filling pattern.
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. iwahashi@ra2.so-net.ne.jp
authors.forename: Noriaki
authors.initials: N
authors.lastname: Iwahashi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Kengo
authors.initials: K
authors.lastname: Tsukahara
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hibi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ebina
authors.forename: Mari
authors.initials: M
authors.lastname: Saito
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000368:Aged; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D042241:Early Diagnosis; D004452:Echocardiography / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate