Short early filling deceleration time on day 1 after acute myocardial infarction is associated with short and long term left ventricular remodelling

• Published in: Heart (British Cardiac Society) Vol. 85; no. 5; pp. 527 - 532
• Main Authors: OTASEVIC, P, NESKOVIC, A. N, POPOVIC, Z, VLAHOVIC, A, BOJIC, D, BOJIC, M, POPOVIC, A. D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-05-2001; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: acute myocardial infarction; Adult; Aged; Biological and medical sciences; Blood flow; Cardiac arrhythmia; Cardiovascular Medicine; Cardiovascular system; Causes of; Deceleration; deceleration time; Echocardiography; Female; Follow-Up Studies; Forecasts and trends; Heart attack; Heart attacks; Heart failure; Heart rate; Heart ventricle, Left; Humans; Investigative techniques, diagnostic techniques (general aspects); left ventricular remodelling; Male; Measurement; Medical imaging; Medical sciences; Methods; Middle Aged; Mortality; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Pain; Prognosis; Prospective Studies; ROC Curve; Stroke Volume - physiology; Studies; Survival Rate; Time Factors; Ultrasonic investigative techniques; Ultrasonography; Ventricular Function, Left - physiology; Ventricular Remodeling - physiology; United Kingdom; Sonography; Short term; Human; Echocardiography; Prognosis; Infarct; Pathophysiology; Deceleration; Acute; Cardiovascular disease; Exploration; Remodeling; Coronary heart disease; Myocardial disease; Long term; Left ventricle; Risk factor; Myocardium; Filling; Hemodynamics
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heart.85.5.527

OBJECTIVE To assess the relations between early filling deceleration time, left ventricular remodelling, and cardiac mortality in an unselected group of postinfarction patients. DESIGN AND PATIENTS Prospective evaluation of 131 consecutive patients with first acute myocardial infarction. Echocardiography was performed on day 1, day 2, day 3, day 7, at three and six weeks, and at three, six, and 12 months after infarction. According to deceleration time on day 1, patients were divided into groups with short (< 150 ms) and normal deceleration time (⩾ 150 ms). SETTING Tertiary care centre. RESULTS Patients with a short deceleration time had higher end systolic and end diastolic volume indices and a higher wall motion score index, but a lower ejection fraction, in the year after infarction. These patients also showed a significant increase in end diastolic (p < 0.001) and end systolic volume indices (p = 0.007) during the follow up period, while ejection fraction and wall motion score index remained unchanged. In the group with normal deceleration time, end diastolic volume index increased (p < 0.001) but end systolic volume index did not change; in addition, the ejection fraction increased (p = 0.002) and the wall motion score index decreased (p < 0.001). One year and five year survival analysis showed greater cardiac mortality in patients with a short deceleration time (p = 0.04 and p = 0.02, respectively). In a Cox model, which included initial ejection fraction, infarct location, and infarct size, deceleration time on day 1 was the only significant predictor of five year mortality. CONCLUSIONS A short deceleration time on day 1 after acute myocardial infarction can identify patients who are likely to undergo left ventricular remodelling in the following year. These patients have a higher one year and five year cardiac mortality.