Combined myocardial performance index as an echocardiographic predictor of prognosis in acute ST-elevation myocardial infarction

Abstract

Abstract Background Myocardial infarction induces variable degrees of impairment in left ventricular (LV) systolic and diastolic functions. Right ventricular (RV) dysfunction can occasionally coexist with LV dysfunction. The most popular techniques for assessing systolic and diastolic function, respectively, the ejection fraction (EF) and transmitral flow, both have significant limitations. The myocardial performance index (MPI) is a single parameter that does not have these restrictions and can estimate both combined systolic and diastolic performance. We used the combined myocardial performance index (CMPI) (LV MPI + RV MPI) as a new predictor of prognosis in patients with ST-elevation myocardial infarction (STEMI). Objectives The purpose of this study was to evaluate the CMPI as an echocardiographic prognostic indicator in STEMI patients. Methods 200 STEMI patients who underwent primary PCI were enrolled. Echocardiography was done within 24 h of clinical signs with measurement of LV MPI and RV MPI. The MPI was calculated as (isovolumic contraction time + relaxation time)/ejection time. The one-year cardiovascular mortality rate from the time of admission was selected as a prognostic indicator. Results The one-year cardiovascular mortality rate was 9% (18 patients). LV MPI was found to have a significant positive correlation with the development of 1-year death (p = 0.036), while CMPI was found to have a highly significant positive correlation (p = 0.0001). A cut-off point of MPI > 0.50 showed 65.9% specificity and 94.4% sensitivity for the prediction of one-year death (Area-0.659). On the other hand, a cut-off point of CMPI > 0.92 has shown 94.4% sensitivity and 95.1% specificity for identifying patients with a one-year death risk (Area - 0891). Conclusions The CMPI might be a strong prognostic predictor after acute STEMI.LVMPICMPI