Abstract 12411: Diastolic Function Determines the Prognosis of Myocardial Infarction

Abstract

Introduction: Myocardial infarction (MI) can produce both systolic and diastolic dysfunction. Systolic dysfunction apparent as a reduced ejection fraction (EF) is accepted as an indicator of poor prognosis following MI. However, diastolic dysfunction causes heart failure even in the patients with a preserved EF. Hypothesis: Diastolic function may determine the prognosis of myocardial infarction.

Methods: We studied 414 consecutive patients treated for myocardial infarction at Wake Forest Baptist Medical Center who had a complete echocardiogram within 6 months. Forty-three patients were graded as normal diastolic function, 46 impaired relaxation, 148 pseudo-normal filling and 177 restrictive filling (RF) according to the EAE/ASE recommendations. The mitral annular velocities were the mean of lateral and septal measurements.

Results: Mean age±SD was 61±13 years old. Male was 67%. Mean EF was 46±13%. The median follow up period was 369 days. The patients with the RF pattern had a worse prognosis than the patients without the RF pattern (Figure). Univariable analyses revealed that age, EF, e' , s' and E/e' were significant predictors of all cause death; odds ratio (OR) and 95% confidence interval (CI) were 1.05 (1.03-1.08), 0.97 (0.95-0.996), 0.80 (0.69-0.94), 0.76 (0.63-0.93) and 1.07 (10.4-1.11), respectively. In the multivariable analysis we found that EF, s' were not prognostic predictors but that age, male gender and E/e' were the predictors of all cause death; OR and 95%CI were 1.06 (1.03-1.09), 3.67 (1.49-9.04) and 1.09 (1.03-1.16).

Conclusions: Diastolic dysfunction determines the prognosis of myocardial infarction.