Prognostic Implications of Doppler-derived Indexes of Pulmonary Venous Flow after Acute Myocardial Infarction

Joo, Seung Jae; Lee, Jae Woo

Abstract

BACKGROUND AND OBJECTIVES
Doppler indexes of pulmonary venous flow (PVF) have been recognized to be useful in defining left ventricular filling characteristics, but their long-term prognostic value in patients with acute myocardial infarction (AMI) is not clear. The purpose of this study was to determine the prognostic significance of Doppler indexes of PVF after AMI.
SUBJECTS AND METHODS
Doppler echocardiographic examination was performed in 122 patients with AMI between 7 to 10 days after attack, and followed for 30 months. Peak systolic velocity (PVs), peak diastolic velocity (PVd), and peak reverse flow velocity associated with atrial contraction (PVa) of PVF were measured by transthoracic echocardiography. End-points were cardiac death or readmission due to congestive heart failure (re-CHF).
RESULTS
There were 9 deaths (7.4%) and 13 patients with re-CHF (10.7%) during the follow-up period. Patients with events had higher PVa (p=0.039). Subgroup analysis of patients with E/A ratio > 1 showed that they had lower PVs/PVd ratio (p=0.029) and higher PVa (p=0.069). Event-free survival was significantly lower in patients with PVs/PVd ratio < 1.3 (30-month survival rate 74% vs. 100% in those with PVs/PVd ratio > or =1.3). Multivariate Cox analysis revealed that Killip class II, and EF <50% were independent predictors of cardiac events; and PVa > or =25 cm/sec as well as age > or =65 years were independent predictors of cardiac mortality in patients with E/A ratio >1.
CONCLUSION
PVa and PVs/PVd ratio of PVF were helpful indexes in predicting the prognosis in patients with AMI and an E/A ratio of >1.