TY - JOUR
T1 - Noninvasive assessment of left ventricular filling pressure after acute myocardial infarction
T2 - A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide
AU - Kruszewski, Kirsten
AU - Scott, Anne E.
AU - Barclay, Justin L.
AU - Small, Gary R.
AU - Croal, Bernard L.
AU - Møller, Jacob E.
AU - Oh, Jae K.
AU - Hillis, Graham S.
N1 - Funding Information:
The study was funded by the British Heart Foundation and the Scottish Government, Chief Scientist Office, and approved by the Grampian Research Ethics Committee. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.
PY - 2010/1
Y1 - 2010/1
N2 - Background: Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this. Methods: Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years). Results: Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both). Conclusions: The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.
AB - Background: Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this. Methods: Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years). Results: Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both). Conclusions: The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.
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U2 - 10.1016/j.ahj.2009.10.032
DO - 10.1016/j.ahj.2009.10.032
M3 - Article
C2 - 20102866
AN - SCOPUS:71949124828
SN - 0002-8703
VL - 159
SP - 47
EP - 54
JO - American heart journal
JF - American heart journal
IS - 1
ER -