E/e’ as a Predictor of Short-Term Survival Following ST-Elevation Myocardial Infarction

Sivaprasad Naidu Nallapati, Adikesava Naidu Otikunta, Y. V. Subba Reddy, Ravi Srinivas

Department of Cardiology, Osmania General Hospital and Osmania Medical College, Hyderabad, India.

DOI: 10.4236/ijcm.2015.611109                

Abstract

Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) in unselected patients with acute ST-elevation myocardial infarction (STEMI). Methods: Patients presenting with acute STEMI at Osmania General Hospital, Hyderabad, India between January-2012 and June-2012 were examined in this study. All patients underwent echocardiographic examination comprising Doppler assessment of transmitral flow velocities (peak E-wave velocity) and Doppler tissue imaging of the medial mitral valve annulus (e’). All patients were followed up for 6 months and all-cause mortality was measured as the study endpoint. Role of E/e’ ratio as a predictor of survival after acute STEMI was evaluated by a comparative analysis of patients with E/e’ ≤15 and >15. Results: A total of 50 patients with acute STEMI (mean age: 52.2 ± 13.2 years; 80% males) were analyzed in this study. Of them, 23 (46%) patients had an E/e’ >15. Clinical parameters such as Killip class ≥2 as well as left ventricular ejection fraction of <40% were significantly associated with E/e’ >15. Five (10%) patients died during the 6-month follow-up period. All deaths occurred among patients from the E/e’ >15 group, indicating that E/e’ is an effective predictor of overall survival. Conclusion: E/e’ ratio was identified as a strong predictor of survival after acute myocardial infarction and can be suitable for risk-stratification of patients in this setting. Further studies are warranted to substantiate the findings.

Keywords

ST-Elevated Myocardial Infarction, Echocardiography, Transmitral Flow Velocity, Medial Mitral Valve Annulus, E/e’ Ratio, Survival

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Gaziano, T.A., Bitton, A., Anand, S., Abrahams-Gessel, S. and Murphy, A. (2010) Growing Epidemic of Coronary Heart Disease in Low- and Middle-Income Countries. Current Problems in Cardiology, 35, 72-115. http://dx.doi.org/10.1016/j.cpcardiol.2009.10.002
[2]	Hillis, G.S., Moller, J.E., Pellikka, P.A., Gersh, B.J., Wright, R.S., Ommen, S.R., Reeder, G.S. and Oh, J.K. (2004) Noninvasive Estimation of Left Ventricular Filling Pressure by E/e' Is a Powerful Predictor of Survival after Acute Myocardial Infarction. Journal of the American College of Cardiology, 43, 360-367. http://dx.doi.org/10.1016/j.jacc.2003.07.044
[3]	Park, J.H. and Marwick, T.H. (2011) Use and Limitations of E/e' to Assess Left Ventricular Filling Pressure by Echocardiography. Journal of Cardiovascular Ultrasound, 19, 169-173. http://dx.doi.org/10.4250/jcu.2011.19.4.169
[4]	Liang, H.Y., Cauduro, S.A., Pellikka, P.A., Bailey, K.R., Grossardt, B.R., Yang, E.H., Rihal, C., Seward, J.B., Miller, F.A. and Abraham, T.P. (2006) Comparison of Usefulness of Echocardiographic Doppler Variables to Left Ventricular End-Diastolic Pressure in Predicting Future Heart Failure Events. American Journal of Cardiology, 97, 866-871. http://dx.doi.org/10.1016/j.amjcard.2005.09.136
[5]	Ommen, S.R., Nishimura, R.A., Appleton, C.P., Miller, F.A., Oh, J.K., Redfield, M.M. and Tajik, A.J. (2000) Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures: A Comparative Simultaneous Doppler-Catheterization Study. Circulation, 102, 1788-1794. http://dx.doi.org/10.1161/01.CIR.102.15.1788
[6]	Poulsen, S.H. (2001) Clinical Aspects of Left Ventricular Diastolic Function Assessed by Doppler Echocardiography Following Acute Myocardial Infarction. Danish Medical Bulletin, 48, 199-210.
[7]	Nagueh, S.F., Appleton, C.P., Gillebert, T.C., Marino, P.N., Oh, J.K., Smiseth, O.A., Waggoner, A.D., Flachskampf, F.A., Pellikka, P.A. and Evangelisa, A. (2009) Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. European Journal of Echocardiography, 10, 165-193. http://dx.doi.org/10.1093/ejechocard/jep007
[8]	Cerisano, G. and Bolognese, L. (2001) Echo-Doppler Evaluation of Left Ventricular Diastolic Dysfunction during Acute Myocardial Infarction: Methodological, Clinical and Prognostic Implications. Italian Heart Journal, 2, 13-20.
[9]	Shanks, M., Ng, A.C., van de Veire, N.R., Antoni, M.L., Bertini, M., Delgado, V., Nucifora, G., Holman, E.R., Choy, J.B., Leung, D.Y., Schalij, M.J. and Bax, J.J. (2010) Incremental Prognostic Value of Novel Left Ventricular Diastolic Indexes for Prediction of Clinical Outcome in Patients with ST-Elevation Myocardial Infarction. American Journal of Cardiology, 105, 592-597. http://dx.doi.org/10.1016/j.amjcard.2009.10.039
[10]	Obeidat, O., Alam, M., Divine, G.W., Khaja, F., Goldstein, S. and Sabbah, H. (2004) Echocardiographic Predictors of Prognosis after First Acute Myocardial Infarction. American Journal of Cardiology, 94, 1278-1280. http://dx.doi.org/10.1016/j.amjcard.2004.07.112