Serial Echocardiographic Assessment of Left Ventricular Filling Pressure and Remodeling among ST Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Intervention

Background: Acute myocardial infarction and remodeling of the left ventricle (LV) is associated with significant changes in systolic and diastolic echocardiographic derived indices. We have tried to determine whether persistence of increased transmitral flow velo­city (E) to early mitral annulus velocity (e`) ratio (E/e`), signifying increased cardiac filling pressure, is associated with LV remodeling and increased chamber size among patients presenting with ST- elevation MI (STEMI), who underwent successful reperfusion with primary percutaneous coronary intervention (PCI).

Methods: We retrospectively studied fifty two patients (76% males, mean age 61 + 10 years) with first STEMI, who underwent primary PCI. Echocardiography was performed at day 1-3 and after a median of 6 months. Patients were stratified according to E/e` ratio above and below 15 in both exams. All patients received optimal medical therapy according to guidelines and local practice.

Results: Patients with maintained or worsened E/e` ratio to a level >15 demonstrated on the 2^nd exam worse LV ejection fraction (45 ± 12 %v. 52 ±8 %, p=0.03), higher indexed LV end diastolic (76.7 ± 22.8 ml/m² vs. 61.9 ± 15.4 ml/m², p=0.02) and end systolic (34.4 ± 23.4 ml/m² vs. 22.7 ±14.9 ml/m², p=0.07) volumes compared with the 1^st examination, representing LV remodeling. A positive correlation was found between a subsequent increase in the E/e’ ratio and increased LV end diastolic volume (R²Linear = 0.223, p < 0.001)

Conclusions: Among STEMI patients undergoing primary PCI early and persistent elevation of the E/e` ratio may be associated with LV remodeling.