Prognostic Value of Doppler Transmitral Flow Velocity Patterns in Acute Myocardial Infarction

Doppler transmitral flow patterns are partially dependent on age. We investigated the correlations between the age-adjusted transmitral flow patterns, hemodynamic indexes, and the coronary and clinical outcome in 206 patients with acute myocardial infarction (AMI) and 102 normal control subjects. The peak flow velocity at atrial contraction was significantly lower in 50 of the 206 patients (24%) (low-A group) than in the 102 normal controls. Pulmonary capillary wedge pressure was significantly higher in the low-A group than in the remaining 156 patients with AMI (20 ± 7 vs 11 ± 5 mm Hg, p <0.001), and the cardiac index and left ventricular ejection fraction were significantly lower (2.2 ± 0.6 vs 2.9 ± 0.7 L/min/m2, p <0.001; 38 ± 15% vs 52 ± 13%, p <0.001). The incidence of cardiogenic shock was significantly higher in the low-A group than in the other patients with AMI (42% vs 19%, p <0.001). Regression analysis demonstrated a significant association between decreased atrial filling velocity and increased in-hospital mortality as well as the incidence of heart failure in AMI (p <0.001). The 5-year mortality rate was also significantly higher in the low-A group (p <0.001). The age-adjusted transmitral flow pattern in AMI can identify patients with left ventricular dysfunction, which can lead to a poor prognosis. Doppler echocardiography was performed in 206 patients with acute myocardial infarction and 102 normal subjects. Peak flow velocity at atrial contraction was significantly lower in 50 patients with myocardial infarction (24.5%) (low-A group) than in the age-adjusted controls. Pulmonary capillary wedge pressure was significantly higher and the cardiac index and left ventricular ejection fraction were significantly lower in the low-A group, and the incidences of cardiogenic shock and congestive heart failure as well as the mortality rate were all significantly higher in the low-A group.