Pseudonormal and restrictive filling patterns predict left ventricular dilation and cardiac death after a first myocardial infarction: a serial color M-mode doppler echocardiographic study

OBJECTIVES We sought to assess the prognostic value of left ventricular (LV) filling patterns, as determined by mitral E-wave deceleration time (DT) and color M-mode flow propagation velocity (Vp), on cardiac death and serial changes in LV volumes after a first myocardial infarction (MI). BACKGROUND Combined assessment of DT and Vp allows separation of the effects of compliance and relaxation on LV filling, thereby allowing identification of pseudonormal filling. This may be valuable after MI, where abnormal LV filling is frequently present. METHODS Echocardiography was performed within 24 h, five days and one and three months after MI in 125 unselected consecutive patients. Normal filling was defined as DT 140 to 240 ms and Vp ≥45 cm/s; impaired relaxation as DT ≥240 ms; pseudonormal filling as DT 140 to 240 ms and Vp <45 cm/s; and restrictive filling as DT <140 ms. RESULTS Left ventricular filling was normal in 38 patients; impaired relaxation in 38; pseudonormal in 23; and restrictive in 26. End-systolic and end-diastolic volume indexes were significantly increased during the first three months after MI in patients with pseudonormal or restrictive filling (37 ± 15 vs. 47 ± 19 ml/m2, p < 0.0005 and 71 ± 20 vs. 88 ± 24 ml/m2, p < 0.0005, respectively). During a follow-up period of 12 ± 7 months, 33 patients died. Mortality was significantly higher in patients with impaired relaxation (p = 0.02), pseudonormal filling (p < 0.00005) and restrictive filling (p < 0.00005), compared with patients with normal filling. On Cox analysis, restrictive filling (p = 0.003), pseudonormal filling (p = 0.006) and Killip class ≥II (p = 0.008) independently predicted cardiac death, compared with clinical and echocardiographic variables. CONCLUSIONS Pseudonormal or restrictive filling patterns are related to progressive LV dilation and predict cardiac death after a first MI.