Atrioventricular plane displacement: does it predict in-hospital outcome after acute myocardial infarction?

BACKGROUND AND OBJECTIVES Atrioventricular plane displacement is a well-accepted method for assessment of left ventricular systolic function. We explored the ability of atrioventricular plane displacement to predict inhospital outcome in patients with acute ST-elevation myocardial infarction. MATERIALS AND METHODS Ninety three patients with acute ST-elevation myocardial infarction were prospectively included. Each patient underwent trans-thoracic echocardiography for measurement of the ejection fraction by the Simpson's method. Atrioventricular plane displacement was measured from the apical views, assessed in four different regions, namely, the septal, lateral, anterior and inferior ones, and the mean value was calculated. We used a cutoff value to classify patients into a group with atrioventricular plane displacement <10 mm and another with atrioventricular plane displacement > or=10 mm. Similarly, patients were classified into those with ejection fraction <40% and others with ejection fraction a 40%. All patients were followed-up during their in-hospital stay for the occurrence of major adverse cardiac events, namely, death, heart failure, complex ventricular arrhythmias, post-infarction angina, or mechanical complications. RESULTS During the follow-up period (3 +/- 1.5 days), major adverse cardiac events occurred in 16 (72.7%) patients with atrioventricular plane displacement <10 mm, and in 6(8.5%) patients with atrioventricular plane displacement > or =10 mm, p < 0.01. An atrioventricular plane displacement below 10 mm was able to predict the occurrence of major events with a sensitivity 72.7%, specificity 91.5%, negative predictive value (NPV) 91.5%, positive predictive value (PVP) 72.7%. Similarly, an ejection fraction below 40% predicted the occurrence of major events with a sensitivity 72.7%, specificity 90.1%, NPV 91.4%, PVP 69.6%. We found a strong correlation between an atrioventricular plane displacement < 10 mm, and an ejection fraction <40%, p < 0.01. CONCLUSION Left atrioventricular plane displacement below 10 mm, can adequately predict the occurrence of in-hospital major adverse cardiac events after acute ST-elevation myocardial infarction, with a high correlation with ejection fraction below 40%.