Echocardiographic Indices of Increased Left Ventricular Filling Pressure and Dilation After Acute Myocardial Infarction

The relationship between echocardiographic indicators of acute and chronic left ventricular (LV) filling pressure and LV dilation after acute myocardial infarction was assessed in 47 patients. The ratio of early transmitral flow velocity to early mitral annulus velocity (E/e') reflects acute LV filling pressure and the indexed volume of the left atrium is an indicator of chronic LV filling pressure. E/e' was higher (19 vs 10, P = .001) among patients who experienced a greater than 15% increase in indexed LV end-diastolic volume (remodeling group, n = 10). Receiver operating characteristic curve analysis confirmed that E/e' was a predictor of remodeling (area under the curve 0.83, P = .002). Patients with E/e' greater than 15 had a mean increase in indexed LV end-diastolic volume of 9.3 versus 1.7 mL/m² in patients with E/e' 15 or less (P = .01). Multivariable regression analyses confirmed that E/e' was the strongest independent predictor of remodeling in this cohort (odds ratio 1.39, P = .01). There was no relationship between indexed volume of the left atrium and LV dilation. These data suggest that the E/e' ratio may be a useful predictor of LV dilation after acute myocardial infarction. In particular, an E/e' ratio greater than 15 identifies patients at increased risk.