Noninvasive estimation of left ventricular filling pressure by E/e′ is a powerful predictor of survival after acute myocardial infarction
Noninvasive estimation of left ventricular filling pressure by E/e′ is a powerful predictor of survival after acute myocardial infarction
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DOI：
10.1016/j.jacc.2003.07.044
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发表时间：
2004-02-04
影响因子：
24
通讯作者：
Oh, JK
中科院分区：
文献类型：
--
作者：
Hillis, GS;Moller, JE;Oh, JK
本研究的目的是评估急性心肌梗死（MI）后早期无创测量左心室舒张压（LVDP）的预后价值。背景二尖瓣环舒张早期速度（e '）反映了心肌舒张的速率。当与早期传输流速（E）的测量结合时，所得比率（E/e '）与平均LVDP良好相关。特别是，E/e'比>15是平均LVDP升高的极好预测因子。我们假设E/e'比值>15预示急性MI后生存率较差。方法250例AMI患者在入院后1.6天获得超声心动图。患者的平均随访时间为13个月。结果73例（29%）患者的E/e' >15。这与过高的死亡率相关（对数秩统计量21.3，p < 0.0001），并且是生存率的最有力的独立预测因子（风险比4.8，95%置信区间2.1至10.8，p = 0.0002）。增加E/e' > 15改善了包含临床变量和常规超声心动图左心室收缩和舒张功能指标的模型的预后效用（p = 0.001）。在这方面，E/e'比>15优于其他临床或超声心动图特征的上级。此外，它提供了这些参数的预后信息增量。(C)2004年，美国心脏病学会基金会。
OBJECTIVES The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI).BACKGROUND The early diastolic velocity of the mitral valve annulus (e') reflects the rate of myocardial relaxation. When combined with measurement of the early transmittal flow velocity (E), the resultant ratio (E/e') correlates well with mean LVDP. In particular, an E/e' ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e' ratio >15 would predict poorer survival after acute MI.METHODS Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality.RESULTS Seventy-three patients (29%) had an E/e' >15. This was associated with excess mortality (log-rank statistic 21.3, p < 0.0001) and was the most powerful independent predictor of survival (risk ratio 4.8, 95% confidence interval 2.1 to 10.8, p = 0.0002). The addition of E/e' > 15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001).CONCLUSIONS E/e' is a powerful predictor of survival after acute MI. An E/e' ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters. (C) 2004 by the American College of Cardiology Foundation.