Limited efficacy of myocardial tissue doppler for predicting left ventricular filling pressure, severe pulmonary edema, and respiratory failure in acute myocardial infarction

Background: Regional parameters such as E/e (ratio of early-diastolic mitral inflow elocity to early-diastolic mitral annular elocity)may not accurately reflect global left ventricular (L) diastolic function in acutemyocardial infarction (AMI), and the use of these parameters for predicting severe pulmonary edema and respiratory failure during acute phase of AMI is questionable. Methods and Results: Four hundred patients with first AMI were catheterized for possible coronary interention and measurement of L filling pressure (LFP). Although E/regional e correlated linearly with LFP, it was not a sufficient correlation to identify an eleated LFP in AMI. For purposes of assessing LFP, aerage e was no better than regional e. Regarding culprit lesions, the correlation between E/regional e and LFPwas weaker in the single left anterior descending artery (LAD)-culprit AMI than in any other culprit or in multiple-essel disease. Comparisons of L ejection fraction (LEF) reealed weak correlations between LFP and E/regional e in patients with LEF of 45-55%. Seere pulmonary edema and respiratory failure were significantly associated with LEF (for pulmonary edema, OR 0.944, 95% CI 0.908-0.982, p = 0.004; for respiratory failure, OR 0.95, 95% CI 0.910-0.993, p = 0.022) and LFP (for pulmonary edema, OR 1.13, 95% CI 1.074-1.190, p < 0.0001; for respiratory failure, OR 1.077, 95% CI 1.021-1.135, p = 0.006). Although LFP was an independent predictor of severe pulmonary edema and respiratory failure, E/e was a poor substitute for LFP in terms of predictie power (all p > 0.05). Conclusion: E/e has an imperfect efficacy for predicting LFP, severe pulmonary edema and respiratory failure in the acute phase of AMI. (Trial registry: ClinicalTrials.go; No.: NCT01168609; URL: clinicaltrials.go).