Noninvasive Estimation of Left Ventricular Filling Pressure by E/e′ Is a Powerful Predictor of Survival after Acute Myocardial Infarction

Graham S. Hillis, Jacob E. Møller, Patricia Pellikka, Bernard J. Gersh, R. Scott Wright, Steve R. Ommen, Guy S. Reeder, Jae Kuen Oh

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Abstract

OBJECTIVES: The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI). BACKGROUND: The early diastolic velocity of the mitral valve annulus (e′) reflects the rate of myocardial relaxation. When combined with measurement of the early transmitral flow velocity (E), the resultant ratio (E/e′) correlates well with mean LVDP. In particular, an E/e′ ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e′ ratio >15 would predict poorer survival after acute MI. METHODS: Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality. RESULTS: Seventy-three patients (29%) had an E/e′ >15. This was associated with excess mortality (log-rank statistic 21.3, p < 0.0001) and was the most powerful independent predictor of survival (risk ratio 4.8, 95% confidence interval 2.1 to 10.8, p = 0.0002). The addition of E/e′ >15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001). CONCLUSIONS: E/e′ is a powerful predictor of survival after acute MI. An E/e′ ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters.

Original languageEnglish (US)
Pages (from-to)360-367
Number of pages8
JournalJournal of the American College of Cardiology
Volume43
Issue number3
DOIs
StatePublished - Feb 4 2004

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Ventricular Pressure
Myocardial Infarction
Survival
Blood Pressure
Mortality
Mitral Valve

ASJC Scopus subject areas

  • Nursing(all)

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Noninvasive Estimation of Left Ventricular Filling Pressure by E/e′ Is a Powerful Predictor of Survival after Acute Myocardial Infarction. / Hillis, Graham S.; Møller, Jacob E.; Pellikka, Patricia; Gersh, Bernard J.; Wright, R. Scott; Ommen, Steve R.; Reeder, Guy S.; Oh, Jae Kuen.

In: Journal of the American College of Cardiology, Vol. 43, No. 3, 04.02.2004, p. 360-367.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES: The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI). BACKGROUND: The early diastolic velocity of the mitral valve annulus (e′) reflects the rate of myocardial relaxation. When combined with measurement of the early transmitral flow velocity (E), the resultant ratio (E/e′) correlates well with mean LVDP. In particular, an E/e′ ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e′ ratio >15 would predict poorer survival after acute MI. METHODS: Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality. RESULTS: Seventy-three patients (29{\%}) had an E/e′ >15. This was associated with excess mortality (log-rank statistic 21.3, p < 0.0001) and was the most powerful independent predictor of survival (risk ratio 4.8, 95{\%} confidence interval 2.1 to 10.8, p = 0.0002). The addition of E/e′ >15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001). CONCLUSIONS: E/e′ is a powerful predictor of survival after acute MI. An E/e′ ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters.",
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T1 - Noninvasive Estimation of Left Ventricular Filling Pressure by E/e′ Is a Powerful Predictor of Survival after Acute Myocardial Infarction

AU - Hillis, Graham S.

AU - Møller, Jacob E.

AU - Pellikka, Patricia

AU - Gersh, Bernard J.

AU - Wright, R. Scott

AU - Ommen, Steve R.

AU - Reeder, Guy S.

AU - Oh, Jae Kuen

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N2 - OBJECTIVES: The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI). BACKGROUND: The early diastolic velocity of the mitral valve annulus (e′) reflects the rate of myocardial relaxation. When combined with measurement of the early transmitral flow velocity (E), the resultant ratio (E/e′) correlates well with mean LVDP. In particular, an E/e′ ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e′ ratio >15 would predict poorer survival after acute MI. METHODS: Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality. RESULTS: Seventy-three patients (29%) had an E/e′ >15. This was associated with excess mortality (log-rank statistic 21.3, p < 0.0001) and was the most powerful independent predictor of survival (risk ratio 4.8, 95% confidence interval 2.1 to 10.8, p = 0.0002). The addition of E/e′ >15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001). CONCLUSIONS: E/e′ is a powerful predictor of survival after acute MI. An E/e′ ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters.

AB - OBJECTIVES: The aim of this study was to assess the prognostic value of a noninvasive measure of left ventricular diastolic pressure (LVDP) early after acute myocardial infarction (MI). BACKGROUND: The early diastolic velocity of the mitral valve annulus (e′) reflects the rate of myocardial relaxation. When combined with measurement of the early transmitral flow velocity (E), the resultant ratio (E/e′) correlates well with mean LVDP. In particular, an E/e′ ratio >15 is an excellent predictor of an elevated mean LVDP. We hypothesized that an E/e′ ratio >15 would predict poorer survival after acute MI. METHODS: Echocardiograms were obtained in 250 unselected patients 1.6 days after admission for MI. Patients were followed for a median of 13 months. The end point was all-cause mortality. RESULTS: Seventy-three patients (29%) had an E/e′ >15. This was associated with excess mortality (log-rank statistic 21.3, p < 0.0001) and was the most powerful independent predictor of survival (risk ratio 4.8, 95% confidence interval 2.1 to 10.8, p = 0.0002). The addition of E/e′ >15 improved the prognostic utility of a model containing clinical variables and conventional echocardiographic indexes of left ventricular systolic and diastolic function (p = 0.001). CONCLUSIONS: E/e′ is a powerful predictor of survival after acute MI. An E/e′ ratio >15 is superior, in this respect, to other clinical or echocardiographic features. Furthermore, it provides prognostic information incremental to these parameters.

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