The clinical value of mitral A-wave deceleration time in the prediction of a long-term adverse outcome in patients with myocardial infarction.

INTRODUCTION: Mitral A-wave deceleration time (Adt) is a promising Doppler parameter for the evaluation of left ventricular (LV) diastolic function. The aim of the present study was to investigate the long-term prognostic value of Adt in relation to the development of heart failure and cardiac death in the setting of the first acute myocardial infarction (MI). METHODS: Conventional Doppler echocardiographic study and Adt measurements were performed in 105 patients (age 60 +/- 10 years, 77 men) 8.07 +/- 0.96 days post MI. Patients were divided into three groups according to Adt duration: group 1 with Adt > or =70 ms, group 2 with 70 ms < Adt <115 ms, and group 3 with Adt > or =115 ms. RESULTS: Patients of groups 1 (Adt: 64 +/- 5 ms, n=11) and 3 (Adt: 123 +/- 8 ms, n=38) presented characteristics of restrictive physiology or impaired relaxation, respectively, while patients of group 2 (Adt: 92 +/- 9 ms, n=56) had near to normal LV filling characteristics. Patients were followed up for a mean of 44.7 months. Heart failure was found in 4 patients (36%) in group 1 and 6 (16%) in group 3, whereas the patients in group 2 were free of heart failure. Cardiac death occurred in 4 patients (36%) in group 1, 3 (7.9%) in group 3 and 2 (3.6%) in group 2. Kaplan-Meier survival curves indicated that patients with Adt < or =70 ms or Adt > or =115 ms had more frequent cardiac events and a significantly shorter event-free survival period in comparison with those with 70 ms < Adt < 115 ms (p = 0.0017). Cox analysis showed that Adt < or =70 ms (p = 0.002), Adt > or =115 ms (p = 0.02), restrictive LV filling pattern (p = 0.003), anterior wall MI (p = 0.02), ejection fraction (p = 0.03), age (p = 0.04), and treatment with angiotensin converting enzyme inhibitors (p = 0.009) were independent predictors of outcome. CONCLUSIONS: Adt appears to be a strong and independent predictor of heart failure or cardiac death following a MI. A shortened Adt < or =70 ms is associated with higher rates of both cardiac death and heart failure, while a prolonged Adt > or =115 ms is associated with heart failure only.

Arterial stiffness assessed by pulse wave analysis in essential hypertension: relation to 24-h blood pressure profile.

BACKGROUND: Arterial stiffness is a risk factor for cardiovascular morbidity and mortality and appears to be increased in arterial hypertension. The purpose of the present study was to relate systemic arterial stiffness assessed by pulse wave analysis to variables of 24-h ambulatory blood pressure monitoring (ABPM) in patients with essential hypertension. METHODS: Seventy-two subjects with untreated mild to moderate arterial hypertension underwent evaluation with 24-h ambulatory blood pressure monitoring. In the same subjects, applanation tonometry and pulse wave analysis was performed for evaluation of systemic arterial stiffness expressed as augmentation index and estimated aortic pulse wave velocity. RESULTS: Clinic systolic blood pressure, mean heart rate during 24-h blood pressure monitoring and height were independent predictors of augmentation index and estimated aortic pulse wave velocity. The 41 patients with blunted reduction in nighttime blood pressure (nondippers) showed higher mean systolic blood pressure (p=0.02), lower systolic and diastolic blood pressure variability (p<0.001), higher pulse pressure during 24-h monitoring (p=0.05) and higher estimated aortic pulse wave velocity (p=0.03), indicating stiffer arteries in this group. CONCLUSIONS: These results suggest that blood pressure change from day- to nighttime is an important determinant of arterial stiffness assessed by pulse wave analysis; this association could contribute to the higher cardiovascular risk in nondippers.

Tei index as a method of evaluating left ventricular diastolic dysfunction in acute myocardial infarction.

INTRODUCTION: The Doppler index of overall left ventricular (LV) myocardial performance--the Tei index--has been shown to be a reliable indicator of all changes in LV systolic dysfunction, retaining an inverse relationship with the ejection fraction. The aim of this study was to examine the corresponding behaviour in relation to LV diastolic dysfunction in patients with acute myocardial infarction (AMI), a relationship that has not been studied previously. METHODS: The study included 105 patients (77 men) with first AMI who were classified into four groups according to the severity of LV diastolic dysfunction: a) 25 patients with normal diastolic function (NDF), b) 36 with decreased peak filling rate pattern (DFR), c) 33 with impaired relaxation (IR) and d) 11 with pseudonormal or restrictive physiology (PN/RP). A complete echocardiographic study, including all conventional systolic and diastolic echo/Doppler parameters as well as measurement of the Tei index, was performed on the eighth post-infarction day (mean 8.07 +/- 0.96 days) in all patients. RESULTS: In the patients with IR (0.77 +/- 0.05) the index was significantly greater than in those of the NDF (0.55 +/- 0.03, p<0.01) or DFR (0.65 +/- 0.02, p<0.01) groups. The index in the DFR group was greater than in the NDF group, though not significantly so. In contrast, the index in the PN/RP patients (0.59 +/- 0.05) was significantly lower than in the patients with IR (p<0.01), whereas it did not differ from that of the patients in the NDF or DFR groups ("pseudonormalisation" of the index). CONCLUSIONS: The Tei index detects with reliability milder types of diastolic dysfunction. However, because of its "pseudonormalisation" in patients with PN/RP, the Tei index cannot be considered a reliable indicator of more severe patterns of LV diastolic dysfunction in AMI patients.