Serial Echocardiographic Assessment of Left Ventricular Filling Pressure and Remodeling among ST-Segment Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Intervention

Yacov Shacham, Shafik Khoury, Nir Flint, Arie Steinvil, Ben Sadeh, Yaron Arbel, Yan Topilsky, Gad Keren

Research output: Contribution to journalArticlepeer-review

Abstract

Background Acute myocardial infarction and remodeling of the left ventricle is associated with significant changes in systolic and diastolic echocardiographic derived indices. The investigators have tried to determine whether persistence of increased ratio of transmitral flow velocity (E) to early mitral annulus velocity (e′), signifying increased cardiac filling pressure, is associated with left ventricular (LV) remodeling and increased chamber size among patients presenting with ST-segment elevation myocardial infarction, who underwent successful reperfusion with primary percutaneous coronary intervention. Methods Fifty-two patients (76% men; mean age, 61 ± 10 years) with first ST-segment elevation myocardial infarctions who underwent primary percutaneous coronary intervention were retrospectively studied. Echocardiography was performed at baseline (days 1–3) and after 178 ± 62 days. Patients were stratified according to E/septal e′ ratio >15 and ≤15 in both examinations. All patients received optimal medical therapy according to guidelines and local practice. Results Patients with maintained or worsened E/septal e′ ratios to >15 demonstrated on the second examination worse LV ejection fractions (mean, 45 ± 12% vs 52 ± 8%; P = .03) and higher indexed LV end-diastolic volumes (mean, 81.3 ± 22.9 vs 69.2 ± 13.4 mL/m2; P = .01) and end-systolic volumes (mean, 33.0 ± 12.2 vs 23.7 ± 13.4 mL/m2; P = .02) compared with the first examination, representing LV remodeling. Patients with E/septal e′ ratios > 15 on the second examination demonstrated a positive correlation between the change in E/septal e′ ratio and the change in indexed LV end-diastolic volume (linear R2 = 0.344, P = .03). Conclusions Among patients with ST-segment elevation myocardial infarctions undergoing primary percutaneous coronary intervention, early and persistent elevation of the E/septal e′ ratio may be associated with LV remodeling.

Original languageEnglish
Pages (from-to)745-749
Number of pages5
JournalJournal of the American Society of Echocardiography
Volume29
Issue number8
DOIs
StatePublished - 1 Aug 2016

Keywords

  • Filling pressure
  • Myocardial infarction
  • Remodeling
  • Reperfusion

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