Prediction of Heart Failure After Acute Myocardial Infarction: Value of Echocardiogram Measuremnts

pp 161-167

Abstract

Purpose

Prediction of development of congestive heart failure after acute myocardial infarction analyzing systolic and diastolic variables by echocardiography.

Material and method

In a prospective, observational study 83 consecutive patients were analyzed by 2D and Doppler echocardiography within 24 hours post-acute myocardial infarction (62% non-Q wave myocardial infarction, mean age 64.4 ± 13 years old; 58 males). All patients were in Killip and Kimball 1. The echocardiographic variables were: end diastolic diameter, end systolic diameter, shortening fraction, end diastolic volume, end systolic volume, ejection fraction, E peak velocity, A peak velocity, E/A ratio, desaceleration time, and left ventricular global function, index (isovolumetric contraction time +isovolumetric relaxation time/ejection time) previous validated.

Results

During the follow-up (112 ± 103 days) 23 patients(27%) developed congestive heart failure defined by Killip and Kimball > 1 or according to Framing-ham criteria. In univariate analysis desaceleration time <_ 130 msec (p < 0.004), ejection fraction < 45%(p < 0.001), end systolic volume >_ 30 ml/m2 (p <0.0001) left ventricular global function index > 0.48 (p < 0.0001)and E/A ratio (p < 0.04) correlated significatively with the onset of congestive heart failure. Cox model multivariate analysis identified only ejection fraction < 45% (p < 0.01), desaceleration time <_ 130 msec (p < 0.03) and left ventricular global function index > 0.48 (p < 0.001) as predictors of congestive heart failure in the follow-up. After adjusted by age, gender, acute myocardial infarction localization, Q or non-Q wave myocardial infarction and CK peak only ejection fraction < 45%(RR: 2.9 [CI 95% 1.8-12.3]; p < 0.03) and left ventricular global function index > 0.48 (RR: 6.7 [CI95% 2.9-17.21; p < 0.0001) provided independent prognostic information.

Conclusions

The early utilization of echocardiography in patients with acute myocardial infarction provided important prognostic information. Left ventricular global function index was the best predictor of congestive heart failure after acute myocardial infarction.