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

BackgroundLeft 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.MethodsEchocardiography 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.ResultsEarly 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.ConclusionFor 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.

Echocardiographic predictors of early in- hospital heart failure during first ST-elevation myocardial infarction

“…E/A ratio were analyzed, a mean of 0.844 was observed in patients with CHF killip>II and a mean 1.08 in those with absent which was not statistically significant. Similar result were observed in study by Lilian P Souza et al 3 , where as Poulsen et al 4 , they observed a significant association between E/A >1.5 and HF. LVESVI and LVEDVI were also analyzed no significant association was obsereved, similar conclusion was made by Souza et al 3 and Poulsen et al 5 in their studies.…”

“…Similar result were observed in study by Lilian P Souza et al 3 , where as Poulsen et al 4 , they observed a significant association between E/A >1.5 and HF. LVESVI and LVEDVI were also analyzed no significant association was obsereved, similar conclusion was made by Souza et al 3 and Poulsen et al 5 in their studies. Left atrial volume index (LAVI) was also analyzed, the mean LAVI in patients with HF killip>II was 28.96 and those without HF was 22.55 which was statistically significant (p 0.01).…”

“…The incidence of HF has dramatically increased due to increasing role of coronary artery disease and hence early detection of patients with AMI at risk of development of in hospital failure is necessary to limit myocardial injury and LV dysfunction 1 . Left ventricular systolic functions have been extensively studied in relation to heart failure, however it has now become apparent that left ventricular diastolic function contributes to signs and symptoms of clinical heart failure 3 . An increasing number of studies have reported the use of several indices like the ejection fraction, left atrial volume and diastolic indices like E/A ratio, deceleration time in predicting early in-hospital failure in patients with ST elevation myocardial infarction 3 .…”

“…Left ventricular systolic functions have been extensively studied in relation to heart failure, however it has now become apparent that left ventricular diastolic function contributes to signs and symptoms of clinical heart failure 3 . An increasing number of studies have reported the use of several indices like the ejection fraction, left atrial volume and diastolic indices like E/A ratio, deceleration time in predicting early in-hospital failure in patients with ST elevation myocardial infarction 3 . Some studies also showed the use Myocardial Performance Index and Left Atrial Volume comparison to conventional parameters like ejection fraction in predicting early in-hospital failure in patients with ST elevation myocardial infarction.…”

Prognostic Value of Cardiac Time Intervals by Tissue Doppler Imaging M-Mode in Patients With Acute ST-Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

“…[21][22][23][24][25] Our study is the first to evaluate the prognostic value of the MPI assessed by TDI M-mode through the mitral leaflet in an STEMI population treated by pPCI. Previous studies on the predictive power of the MPI in patients with AMI have included patients with both non-STEMI and STEMI treated with either thrombolytic therapy or PCI.…”