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European Heart Journal 1995 16(4):496-505;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Heart failure after myocardial infarction: the importance of diastolic dysfunction

A prospective clinical and echocardiographic study

H. PERSSON, E. LINDER-KLINGSELL, S. V. ERIKSSON and L. ERHARDT*

Section of Cardiology, Division of Internal Medicine, Karolinska Institutet, Danderyd Hospital Sweden

revised 29 August 1994; accepted 22 September 1994.

Abstract

Clinical signs of heart failure based on predefined criteria were analysed in 217 survivors (<75 years of age) of an acute myocardial infarction (AMI). A Doppler investigation and M-mode echocardiography were performed 3–5 days after the index infarction. All patients were stratified according to left ventricular end-diastolic diameter ≤28 mm. m–2 body surface area. Fractional shortening, E-point septal separation, Keren's echo-index based on left ventricular end-diastolic diameter, fractional shortening and E-point septal separation were used as indices of systolic function, and the EI A ratio and isovolumic relaxation time as indices of diastolic function. Fifty-one per cent of the patients (n=111) had heart failure. Left ventricular end-diastolic diameter was <28 mm. m–2 body surface area in 32 (29%) of the heart failure patients and in 44 (45%) of those without heart failure. An abnormal Keren's echo-index was found in 58 (52%) of the heart failure patients compared with 17 (18%) without heart failure. The EIA ratio was lower (0.65 vs 0.77, P=0.01) in heart failure patients with a normal left ventricular end-diastolic diameter compared with patients without heart failure and a normal left ventricular end-diastolic diameter. Infarct size, E-point septal separation, heart rate and age were determinants of heart failure in multivariate analyses with all patients included. Infarct size and the EI A ratio were determinants of heart failure in patients with a normal left ventricular end-diastolic diameter.

Systolic dysfunction is a determinant of heart failure in the majority of patients after AMI, whereas diastolic dysfunction is a determinant of heart failure in patients with a normal left ventricular end-diastolic diameter. Abnormal findings regarding left ventricular diameter and systolic function are present in 55% and 18%, respectively, of the patients without heart failure.

Key Words: Acute myocardial infarction • left ventricular function • diastolic function • Doppler echocardiography • congestive heart failure


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