Non Invasive Assessment of Left Ventricular Filling Pressure and Remodeling after Acute Myocardial Infarction

Background: Left ventricular (LV) dilation after acute myocardial infarction (AMI) is an important determinant of prognosis. The ratio of early mitral inflow velocity (E) and peak early diastolic annular velocity (e') provides the best single index for noninvasive detection of acute elevation of LV filling pressure. Objective: To assess whether E/e' ratio predicts LV remodeling after properly treated AMI compared with traditional clinical, laboratory and echocardiographic data. Methods: Comprehensive echocardiograms were performed in a series of consecutive patients with first AMI successfully treated with primary percutaneous transluminal angioplasty (PTCA), both 48 hours after intervention and 60 days later. Mean E/e' was determined from four sites of the mitral annulus. LV remodeling was defined as more than 15% increase in end-systolic volume estimated by Simpson method. Statistical analysis included Student's t test, receiver-operator curves (ROC) and multivariate logistic regression (all significant with p < 0.05). Results: Fifty-five patients were included, with mean age 58 +/- 11 years, 43 men. The group of patients who underwent LV remodeling (n = 13) had higher baseline E/e' than those without (13 +/- 4 versus 8.5 +/- 2, p < 0.001). The ROC curve showed E/e' > 15 as a predictor of remodeling (AUC = 0.81, p = 0.001). In addition, regression analysis (comprising clinical, laboratory and echocardiographic variables along with AMI site) confirmed the independent value of E/e' in the prediction of LV remodeling (odds ratio 1.42, p = 0.01). Conclusion: The E/e' ratio is an useful predictor of LV remodeling after AMI, indicating patients with increased cardiovascular risk