Change of the new left ventricular function index (TEI INDEX) in acute myocardial infarction

Abstract

It is well known that restrictive transmitral flow(TMF) pattern is predictive of higher cardiac mortality in patients(pts) with chronic heart failure(CHF). However, prognostic value of non-restrictive TMF pattem(NR) in pts with CHF is still unknown. We evaluated changes in left ventdcular(LV) filling with low dose dobutamine stress echocardiography(DSE) and assessed the prognostic significance of changes of LV filling in pts with CHF showing NR. Low dose (10mcg /kg/min) DSE was performed in 45 pts(36men, age 60+11 years) with CHF(35 pts with prior myocardial infarction, 10 with dilated cardiomyopathy) in NYHA class I1-111 with a mean LVEF of 40+13%. Pts were followed over 22+7 months for cardiac events. We measured peak velocities of eady(E) and late(A) diastolic TMF. Isovotumetdc relaxation time(IRT:msec) and deceleration time(DT:msec) of TMF were also measured. We obtained LV outflow time-velocity integrals(OTI) as an index of stroke volume. Then, we evaluated the relations between the changes(A) of these variables during DSE and cardiac events. Pts were subdivided into two groups who had cardiac events(CE:16pts) and had not(NCE:29pts)during followed period. In NCE, percent& IRT shortened significantly during DSE compared to that in CE (NCE:-25% vs CE:-2.4%, p<0.01).ADT,&A/E and AOTI did no~ differ between the two groups. Multivariate analysis showed thatA IRT was the only independent predictor of cardiac events (p<0.01). Conclusions: The shortening of IRT with dobutamine was significantly related to less cardiac event in pts with CHF, suggesting that preserved lusitropy might have favorable effects on the clinical outcome in pts with CHF. Assessment of LV diastolic property with DSE might be useful to predict the outcome in pts with mild to moderate CHF.