A novel Doppler echocardiographic score reflecting cardiac functional status can predict adverse outcome in acute myocardial infarction

BACKGROUND E/e' and s' are thought to reflect left ventricular diastolic and systolic function, respectively. However, there are no reports on the combined use of E/e' and s' in predicting the outcome in acute myocardial infarction (AMI). METHODS For 20 months beginning in October 2006, we enrolled 65 AMI patients who had undergone Swan-Ganz (SG) catheterization and echocardiography just after reperfusion therapy. We measured the cardiac index (CI) and the pulmonary capillary wedge pressure (PCWP) via an SG catheter and determined routine echocardiographic indices, including transmitral flow velocity (E), mitral annulus velocities at systole (s') and early diastole (e'), and E/e'. In addition, we rounded off the values of s' (cm/s) and E/e' (ratio of cm/s to cm/s) to the nearest integer, and designated them the s'-score and E/e'-score, respectively. We also defined the cardiac status score as the s'-score subtracted from the E/e'-score. In Study 1, we investigated the relationships between hemodynamic parameters (CI and PCWP) and echocardiographic indices, including the cardiac status score. In Study 2, we excluded patients with Killip class ≥II, yielding a final study population of 55 patients in whom we investigated whether the cardiac status score could predict adverse cardiac events. RESULTS Only the cardiac status score significantly correlated with both the PCWP and the CI. In the Cox proportional hazards model, significant predictors were the left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), and cardiac score ≥3.0. CONCLUSIONS The novel score achieved in this study by subtracting the s'-score from the E/e'-score could be highly useful for predicting outcomes in AMI with Killip class I.