Prognostic value of left ventricular diastolic function and association with heart rate variability after a first acute myocardial infarction

Abstract

Objective-To study the prognostic value of left ventricular (LV) diastolic function and its relation with autonomic balance expressed by heart rate variability (HRV) in patients after a first acute myocardial infarction. Design-The study population consisted of 64 consecutive patients with first acute myocardial infarction and 31 control subjects. Long and short term HRV indices were evaluated by 24 hour Holter monitoring, and LV systolic and diastolic function were assessed by two dimensional and Doppler echocardiography before discharge. Patients were divided into two groups: those with restrictive LV filling characteristics (deceleration time < 140 ms) and those with non-restrictive LV filling characteristics (deceleration time > 140 ms). Results-Both long and short term HRV indices were significantly reduced in patients with restrictive LV filling compared with the non-restrictive group and control subjects. Mitral deceleration time and isovolumetric relaxation time correlated weakly but significantly with all indices of HRV whereas ejection fraction correlated weakly with the long term HRV indices. The mean follow up time was 14.9 (8.7) months. Multivariate analysis showed that mitral deceleration time ( 2 = 6.4, p < 0.001) and ejection fraction < 40% ( 2 = 4.4, p < 0.05) were independent predictors of cardiac death and readmission to hospital with congestive heart failure. Conclusions-A restrictive LV filling pattern was found to be the strongest predictor of adverse outcome independent of HRV and ejection fraction during follow up after a first acute myocardial infarction. Patients with restrictive LV filling characteristics had more reduced HRV than those with non-restrictive diastolic filling. (Heart 2001;86:376-380)

Is glycated haemoglobin a sensitive index to identify left ventricular dysfunction two months after acute myocardial infarction in normotensive subjects?

“…Impaired relaxation was defined as an E/A < 1 [19]. As previously defined [20,21] , when E/A was > 1 but < 2 associated with DT (deceleration time of the E wave) < 140 ms or when E/ A > 2 the pattern of LV filling was defined as restrictive. A non-restrictive pattern of LV filling was defined by an E/ A < 1 or by E/A between 1 and 2 associated with DT > 140 ms. Isovolumic relaxation time (IVRT) was also measured as the time from the end of the A wave to the beginning of the aortic Doppler ultrasound wave.…”

Left ventricular response to sustained volume overload from chronic aortic valve regurgitation in rats

“…Compared to systolic function, diastolic function has received little attention in humans suffering from severe aortic regurgitation 52,53 . However, it has been suggested that abnormalities in diastolic function may influence the symptomatic status as well as the prognosis of subjects with severe aortic regurgitation as in other cardiac diseases such as myocardial infarction, congestive heart failure, diabetes and hypertension [54][55][56][57][58][59] . The occurrence of left ventricular filling abnormalities in our animals therefore deserves further attention and investigation.…”

Specific Tissue Doppler Predictors of Preserved Systolic and Diastolic Left Ventricular Function after an Acute Anterior Myocardial Infarction

“…[1][2][3] The clinical course of patients with acute anterior myocardial infarction (AMI) is related to the degree of left ventricular functional impairment. [4][5][6] Previous studies assessing TDE velocities of different mitral annular corners and myocardial segments in acute myocardial infarctions demonstrated the alterations in tissue velocities that are not limited to the infarct-related regions but also involve remote areas in the left ventricle. 7,8) The objective of the present study was to investigate whether relatively preserved systolic and diastolic performances, which are traditionally assessed with the ejection fraction (EF) and deceleration time of early diastolic filling (DT), could be predicted by some parameters obtained from the TDE profiles of septal, lateral, anterior, and inferior mitral annulus corners in patients suffering a first acute AMI.…”