ASE: Diastolic Dysfunction Predicts MI or Coronary Disease Readmission

SEATTLE, June 25 -- Severe diastolic dysfunction tops all other echocardiograhic measures as a post-MI prognostic marker, researchers reported here.

The finding came from a prospective evaluation of 199 patients with a history of coronary artery disease (N=36), ST-segment elevation MI (N=118), or heart failure (N=8), according to Taiyeb Khumri, M.D., of the Mid-America Heart Institute in Kansas City.

All had complete echocardiographic assessments at index admission, he and colleagues said at the American Society of Echocardiography meeting.

In the first year after the index admission, more than three fourths of patients with severe diastolic dysfunction were readmitted for cardiovascular reasons. Evaluation of all patients readmitted during the first year showed that severe dysfunction was the only echocardiographic predictor of readmission.

Reviewing the background of the study, Dr. Khumri noted that diastolic dysfunction is a common finding after acute MI, and left-ventricular diastolic dysfunction predicts in-hospital heart failure, subsequent left-ventricular remodeling, and long-term mortality.

Although Doppler echo is useful for assessing left-ventricular diastolic function, echo-related factors associated with the risk of readmission had not been examined carefully.

Echocardiographic exams of the 199 patients showed that 18 had severely abnormal diastolic function. During the 12 months after infarction, 78% were rehospitalized. Overall, 82 of the 199 patients were rehospitalized for cardiovascular reasons within a year of their index admission.

The Kansas City investigators performed a multivariate analysis on more than 20 variables that could influence the risk of rehospitalization at 12 months. The only factors that proved to be significant predictors were education (P=0.02), peripheral arterial disease (P=0.007), previous angina (P=0.028), and severe diastolic dysfunction (P=0.018).

A total of 74 patients had a left-ventricular ejection fraction of less than 40% at the index admission. The multivariate analysis initially suggested that ejection fraction significantly influenced the risk of rehospitalization (P=0.035), but statistical confidence intervals associated with that P-value crossed the 1.0 threshold.