Abstract 12198: Left Ventricular Filling Pressure Assessed by E/e' of Women is Higher than Men in Patients with a First ST Elevation Acute Myocardial Infarction

Abstract

<Background> Many studies of sex-related differences in the short and long term outcomes of acute myocardial infarction (AMI) have concluded that mortality is higher among women than men. However, the obvious reason for poorer outcomes in women remains unclear. We examined differences between men and women in terms of the echocardiographic features of ST-segment elevation AMI (STEMI).

<Methods> Consecutive 289 patients with a first STEMI (age=64 ± 12y.o., women = 55 patients) were enrolled. All patients successfully underwent reperfusion therapy by PCI within 12 hours of onset. Echocardiography was performed 2 weeks later, and patients were followed up for 36months. We examined tissue Doppler imaging including the early transmitral flow velocity (E)/the early diastolic velocity of the mitral valve annulus (e') - a ratio that strongly correlates with mean left ventricular filling pressure. The primary endpoints were cardiac death and readmission because of heart failure (HF).

<Results> The age of women were higher than men (69.5v.s.62.5, p<0.001). Anterior MI occurred less frequently in women than men (37%v.s.47%, p<0.05). Although women had lower peak CPK/MB (1739/176 vs .2379/206IU/L, p<0.05), E-wave were higher and E/e' were larger (79.6 vs. 70.2 m/sec,13.9 vs.11.9,p<0.01,respectively). Primary endpoints occurred in 25 patients (8 women), 4 patients had cardiac death and 21 patients re-admitted with HF. Table1 shows logistic regression analysis for primary endpoints. Elevated E/e'(>15) was the strongest predictor of primary endpoint within 36months (χ²=48.3, p<0.0001). When we analyzed in terms of their gender, odds ratio of E/e’ was higher (men vs. women = 23.6 vs.31.6), AUC by ROC was higher in women (Table2).

<Conclusions> E/e' of women was higher than men among patients with a first STEMI who underwent successful reperfusion therapy. Elevation of E/e' in women may have more important meaning than in men.