Abnormal filling pattern of the left ventricle and outcome in acute myocardial infarction

Background: The pattern of left ventricular filling by Doppler examination is frequently abnormal in myocardial infarction. Purpose: To relate the different patterns of left ventricular filling to the clinical course of acute myocardial infarction. Patients and methods: We have studied 133 patients with acute myocardial infarction. Three different patterns of mitral flow were defined by Doppler examination: Type I has an E/A ratio lesser than one, and a deceleration time of the E wave longer than 180 ms; Type II has either an E/A ratio greater than one or a deceleration time shorter than 180 ms; Type III has an E/A ratio greater than 1.6 and a deceleration time shorter than 180 ms. We also determined the pulmonary wedge pressure through a pulmonary artery catheter simultaneously with the Doppler examination on 22 occasions in 11 patients. Results: Mortality rate was 13%, 9% and 35% respectively in Type I, II and III (P=0.007). After logistic regression analysis of determinants of death, including all eight variables related with mortality on an univariate analysis, only Killip class and the presence of a Type III pattern of the mitral flow remained significant (P=0.0004 and P=0.019 respectively). Pulmonary wedge pressure was 8.4±6.1 mmHg in Type I, 21.0±7.3 mmHg in Type II, and 22.4±7.1 mmHg in Type III (P=0.0017). Conclusion: Type III pattern of left ventricular filling is an independent predictor of death. Type I and II had no significant differences on prognosis. Type I is associated with a normal pulmonary wedge pressure.