Abstract 11330: E/e’ is a Powerful Predictor of Survival After a First-Ever Non-ST Elevation Myocardial Infarction
Introduction: Significant LV diastolic dysfunction is associated with a poorer prognosis following acute MI. The ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/e’) is a strong non-invasive correlate of LV filling pressures. Septal E/e’ >15 has been well-validated as a predictor of survival in patients with STEMI, with limited data for patients with NSTEMI.
Aim: To assess the prognostic significance of E/e’ measured early after a first-ever NSTEMI. We hypothesised that a septal E/e’ >15 would predict poorer survival following NSTEMI.
Methods: Data analysis on 332 consecutive patients who underwent coronary angiography for a first-ever NSTEMI at a single large tertiary referral centre from January 2013 to December 2014. Transthoracic echocardiography was performed within 24 hours of admission. Outcomes data were obtained from a statewide registry, with the primary endpoint being all-cause mortality.
Results: At a median follow-up time of 36 months, death occurred in 41 (12%) patients. Septal E/e’ was >15 in 66 patients (20%) and was associated with excess mortality (log-rank statistic 17.7, P<0.0001) (Figure 1). On univariate Cox regression analysis, E/e’ >15, age >80 years, diabetes, chronic kidney disease, LVEF, left atrial volume index >34ml/m2 and tricuspid regurgitation peak velocity >2.8m/s were associated with the primary endpoint. On multivariate analysis, E/e’ >15 was an independent predictor of all-cause mortality (HR 2.30, 95%CI 1.24-4.33, p=0.028), as was chronic kidney disease (HR 2.73, 95%CI 1.32-5.66, p=0.007) and LVEF (HR 0.96, 95%CI 0.93-0.98, p=0.001). Furthermore, E/e’ >15 showed incremental prognostic value when added to LVEF.
Conclusion: E/e’ is a powerful, independent predictor of survival following a first-ever NSTEMI. It is superior, in this setting, to most clinical variables and other echocardiographic parameters of diastolic dysfunction, and has additive prognostic value over LVEF.
Author Disclosures: A. Lin: None. C. Kwan: None. J. Sippel: None. K. Guppy-Coles: None. C. Hammett: None. L. Thomas: None. J.J. Atherton: None. S.B. Prasad: None.
- © 2016 by American Heart Association, Inc.