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(Chest. 2003;124:1645-1651.)
© 2003 American College of Chest Physicians

Prognostic Value of Global Myocardial Performance Indices in Acute Myocardial Infarction*

Comparison to Measures of Systolic and Diastolic Left Ventricular Function

Ehud Schwammenthal, MD; Yehuda Adler, MD; Keren Amichai, MD; Alik Sagie, MD; Solomon Behar, MD; Hanoch Hod, MD and Micha S. Feinberg, MD

* From the Heart Institute (Drs. Schwammenthal, Amichai, Behar, Hod, and Feinberg) and Cardiac Rehabilitation Institute (Dr. Adler), Chaim Sheba Medical Center, Tel Hashomer, Israel; and the Department of Cardiology (Dr. Sagie), Rabin Medical Center, Petach-Tiqvah, Israel.

Correspondence to: Ehud Schwammenthal, MD, Heart Institute, Sheba Medical Center, Tel Hashomer, Israel; e-mail: sehud{at}post.tau.ac.il

Study objectives: Assessment of global myocardial performance by a single index (ie, the myocardial performance index [MPI]) has been suggested as an appealing alternative to the individual assessment of systolic and diastolic left ventricular (LV) function We sought to test the prognostic value of MPI in comparison to clinical characteristics and echocardiographic parameters of LV filling and ejection in acute myocardial infarction (AMI).

Patients: Four hundred seventeen consecutive patients with AMI were examined within 24 h of hospital admission.

Interventions: Doppler echocardiographic measures of systolic, diastolic, and global myocardial performance were assessed within 24 h of hospital admission. In addition to MPI (ie, the sum of the isovolumic time intervals divided by ejection time), we determined the isovolumic/heterovolumic time ratio, which expresses the time "wasted" by the myocardium to generate and decrease LV pressure without moving blood.

Results: The end points of the study at 30 days were death (4.7%), congestive heart failure (23%), and recurrent infarction (4.8%), and occurred in 109 patients, who were compared as group B to 314 patients without an event (group A). Multivariate analysis identified only age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.07), LV ejection fraction (LVEF) <= 40% (OR, 3.82; 95% CI, 2.15 to 6.87), and E-wave deceleration time (EDT) of <= 130 ms (OR, 2.29; 95% CI, 1.0 to 5.21) as independent predictors of adverse events.

Conclusion: LVEF and EDT are powerful and independent echocardiographic predictors of poor outcome following AMI, and are superior to indexes of global LV performance. Both parameters should be taken into consideration when deciding about the management of these patients.

Key Words: acute myocardial infarction • diastolic left ventricular function • Doppler echocardiography • myocardial performance index




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