0258: Prognostic value of new diastolic parameter derived from a two-dimensional speckle-tracking study in acute myocardial infarction

Abstract

Diastolic dysfunction in acute myocardial infarction (MI) reflect severe damage and adverse outcome spatially in diabetics patients. Recently, the ratio of early mitral inflow velocity (E) to global diastolic strain rate (e’sr) has been proposed as a marker of elevated LV filling pressure and perhaps a prognostic parameter. The aim of this study to evaluate the E/e’sr ratio in diabetics and its association with adverse outcome in patients with MI. We prospectively included patients with MI and performed echocardiography with comprehensive diastolic evaluation including E/e’sr. 52% were diabetics. We compared the relationship between E/e’sr and the primary composite endpoint (all-cause mortality, hospitalization for heart failure (HF), stroke) in the 2 groups and with Cox models analysis. A total of 458 patients (mean age 59±12, 62% male) were included and 63 patients (13.7%) reached the primary endpoint (median follow-up 13 months). A significant prognostic value was found for E/e’sr [hazard ratio (HR) per 1unit change: 2.56, 95% confidence interval (CI): 1.2-4.55, p<0.0001] in diabetics group. After multivariable adjustment E/e’sr remained independently related to the combined endpoint (HR per 1 unit change, 1.370; CI: 1.01-6.33, P = 0.03). The prognostic value of E/e’sr was correlated to left ventricular ejection fraction on admission, < 35% (r=0.678, p=0.0002)and C reactive protein value, >40 mg/l, (r=0.589, p=0.001). Deformation-based E/e’sr contributes important information about global myocardial relaxation superior to velocity-based analysis in diabetic patients and correlated with left ventricular function and inflammatory status an is independently associated with the outcome in acute MI