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 velocity to early-diastolic mitral annular velocity) may not accurately reflect global left ventricular (LV) diastolic function in acute myocardial infarction (AM1), 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 intervention and measurement of LV filling pressure (LVFP). Although E/regional e' correlated linearly with LVFP, it was not a sufficient correlation to identify an elevated LVFP in AMI. For purposes of assessing LVFP, average e' was no better than regional e'. Regarding culprit lesions, the correlation between E/regional e' and LVFP was weaker in the single left anterior descending artery (LAD)-culprit AMI than in any other culprit or in multiple- vessel disease. Comparisons of LV ejection fraction (LVEF) revealed weak correlations between LVFP and E/regional e' in patients with LVEF of45-55%. Severe pulmonary edema and respiratory failure were significantly associated with LVEF (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 LVFP (for pulmonary edema, OR 1.13, 95% CI 1.074-1. 190, P＜0.0001; for respiratory failure, OR 1.077, 95% CI 1.02 1- 1.135, p = 0.006). Although LVFP was an independent predictor of severe pulmonary edema and respiratory failure, E/e' was a poor substitute for LVFP in terms of predictive power (all p＞0.05).Conclusion: E/e' has an imperfect efficacy for predicting LVFP, severe pulmonary edema and respiratory failure in the acute phase of AMI.