Abstract 2696: Noninvasive Estimation of Left Ventricular Filling Pressure by E/e’ Is a Powerful Predictor of Major Adverse Cardiac and Cerebrovascular Events in Patients with A First ST Elevation Acute Myocardial Infarction
Background: The early diastolic velocity of the mitral valve annulus (e’) combined with measurement of the early transmitral flow velocity(E), the resultant ratio (E/e’) correlates well with mean left ventricular filling pressure. Echocardiographical parameters(including E/e’>15, left atrial volume index≥32ml/m2, ejection fraction<40%) and plasmaBNP>180pg/ml at 3–4 weeks after onset have been reported as a powerful prognostic marker of acute myocardial infarction(AMI). However, there is no study in which patients with first ST elevation(STE)MI were exclusively involved. We examined which is a most reliable prognostic marker for patients with a first STEMI.
Methods: Echocardiography(Aplio, Toshiba) and blood sampling were obtained in consecutive 235 patients 3 weeks after onset of first STEMI(age=64.0y.o., male=187, LMT=4·LAD=108·RCA=101·LCx=22). All patients underwent PCI and were followed for 12 months. The primary end point was major adverse cardiac and cerebrovascular events(MACCE: death from cardiovascular disease, re-infarction and ACS, readmission because of heart failure, and cerebral infarction). Exclusion criteria were non-STEMI, A-C bypass, atrial fibrillation and chronic renal failure on dialysis.
Results: At follow-up, MACCE was occurred in 22 patients (2patients died of heart failure and 6patients had non-fatalMI or ACS, 12 with readmission because of heart failure, 1 with arrhythmia, 3 with stroke). Table⇓ shows the results of univariate and multivariate logistic regression analyses for MACCE. Then, E/e’>15 was a most powerful predictor of MACCE.
Conclusions: E/e’ >15 is a powerful predictor of MACCE within 12 months after a first STEMI.