The early diastolic myocardial velocity: a marker of increased risk in patients with coronary heart disease.
OBJECTIVE
Tissue Doppler imaging (TDI) is a promising echocardiographic modality allowing quantification of myocardial performance. However, the prognostic potential of TDI in patients with acute myocardial infarction (AMI) is not yet investigated. We sought to explore the ability of TDI in identifying patients at risk for new cardiovascular events after AMI.


METHODS
One hundred and nineteen patients with AMI were recruited prospectively (mean age 61 years; range 32-81 years of age). Patients with diabetes mellitus (DM) were excluded. Echocardiography was performed 3-12 months after AMI. Two-dimensional (2-D) and TDI variables were recorded. The patients were followed during a mean period of 4·6 years (range 1-8 years). The primary end-point was defined as any of the following: death from any cause, non-fatal reinfarction or stroke, unstable angina pectoris, congestive heart failure requiring hospitalization and coronary revascularization procedure.


RESULTS
Thirty patients had some form of cardiovascular events during follow-up. Seven patients had cardiovascular death, 13 patients had reinfarction and four patients had a stroke. New angina or unstable angina was recorded in 21 patients. Of these patients, 13 underwent percutaneous coronary angioplasty (PCI) or coronary artery bypass grafting (CABG). The early diastolic myocardial velocity (E(m)) emerged as the only echocardiographic variable that offered a clear differentiation between patients that presented with new cardiovascular (CV) events as compared to the corresponding group without any CV events at follow-up (P<0·05). In multivariate statistical analysis and after adjustment for age, sex, total cholesterol, body mass index (BMI) and other baseline characteristics, Em remained as independent predictors of CV events (HR, 1·18, 95% CI, 1·02-1·36; P<0·05). However, none of the investigated variables evolved as an independent predictor of cardiovascular morbidity and mortality.


CONCLUSIONS
E(m) appears to be a sensitive echocardiographic index in identifying non-diabetic patients with AMI at risk of new cardiovascular events.
School for Technology and Health, Royal Institute of Technology, Stockholm, Sweden.
Jonas
J
Johnson
Aristomenis
A
Manouras
Fredrik
F
Bergholm
Lars Åke
LÅ
Brodin
Stefan
S
Agewall
Loghman
L
Henareh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D025341:Principal Component Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left
early myocardial diastolic velocity; myocardial infarction; tissue velocity imaging