(Circulation. 1999;99:230-236.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Doppler-Derived Mitral Deceleration Time
An Early Strong Predictor of Left Ventricular Remodeling After Reperfused Anterior Acute Myocardial Infarction
From the Division of Cardiology, Careggi Hospital, Florence, Italy.
Correspondence to Giampaolo Cerisano, MD, Division of Cardiology, Careggi Hospital, Viale Morgagni 85, 50134 Firenze. Italy. E-mail carddept{at}tin.it
Background—The relation between remodeling and left ventricular (LV) diastolic function has not yet been fully investigated. The aim of this study was to determine whether early assessment of Doppler-derived mitral deceleration time (DT), a measure of LV compliance and filling, may predict progressive LV dilation after acute myocardial infarction (AMI).
Methods and Results—Fifty-one patients (aged 61±11 years; 6
women) with anterior AMI successfully treated with direct
coronary angioplasty underwent 2-dimensional and Doppler
echocardiographic examinations within 24 hours of
admission, at days 3, 7, and 30 and 6 months after the index
infarction. Mitral flow velocities were obtained from the apical
4-chamber view with pulsed Doppler. End-diastolic
volume index (EDVI) and end-systolic volume index (ESVI) were
calculated with the Simpson's rule algorithm. Patients were divided
according to the DT duration assessed at day 3 in 2 groups: group 1
(n=33) with DT >130 ms and group 2 (n=18) with DT 
130 ms. Patency
and restenosis rate at 6 months were similar between the 2
groups (94% group 1 vs 89% group 2; P=0.52; 27% group
1 vs 33% group 2; P=0.64, respectively). LV volume
indexes were similar in both groups at baseline (EDVI: 71±3 group 1 vs
70±3 mL/m2 group 2, P=0.42; ESVI: 43±3
group 1 vs 48±3 mL/m2 group 2, P=0.13,
respectively). From day 3 on, LV volume indexes progressively increased
in group 2 and were significantly larger than those of group 1 at 6
months (LVEDVI 61±3 group 1 vs 104±6 mL/m2 group 2,
P=0.00001; LVESVI 31±3 group 1 vs 73±6
mL/m2 group 2, P=0.00001, respectively). A
significant inverse correlation was found between DT and changes in
EDVI at 6 months (r=-0.68;
P<0.0000001). By stepwise multiple regression
analysis among several clinical, demographic, angiographic, and
echocardiographic variables, DT was the most
powerful predictor of EDVI changes at 6 months (P=0.02).
Conclusions—These data suggest that early estimation (day 3) of Doppler-derived mitral DT provides a simple and accurate mean to predict late LV dilation after reperfused AMI.
Key Words: diastole • remodeling • myocardial infarction • echocardiography
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