Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide

Kirsten Kruszewski; Anne Scott; Justin Lee Barclay; Gary Robert Small; Bernard L. Croal; Graham Scott Hillis

doi:10.1016/j.ahj.2009.10.032

Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide

Kirsten Kruszewski, Anne Scott, Justin Lee Barclay, Gary Robert Small, Bernard L. Croal, Graham Scott Hillis

Research output: Contribution to journal › Article › peer-review

37 Citations (Scopus)

Abstract

Background
Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this.

Methods
Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years).

Results
Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both).

Conclusions
The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.

Original language	English
Pages (from-to)	47-54
Number of pages	8
Journal	American Heart Journal
Volume	159
Issue number	1
Early online date	16 Dec 2009
DOIs	https://doi.org/10.1016/j.ahj.2009.10.032
Publication status	Published - 1 Jan 2010

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Kruszewski, K., Scott, A., Barclay, J. L., Small, G. R., Croal, B. L., & Hillis, G. S. (2010). Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide. American Heart Journal, 159(1), 47-54. https://doi.org/10.1016/j.ahj.2009.10.032

Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide. / Kruszewski, Kirsten; Scott, Anne; Barclay, Justin Lee et al.
In: American Heart Journal, Vol. 159, No. 1, 01.01.2010, p. 47-54.

Research output: Contribution to journal › Article › peer-review

Kruszewski, K, Scott, A, Barclay, JL, Small, GR, Croal, BL & Hillis, GS 2010, 'Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide', American Heart Journal, vol. 159, no. 1, pp. 47-54. https://doi.org/10.1016/j.ahj.2009.10.032

Kruszewski K, Scott A, Barclay JL, Small GR, Croal BL, Hillis GS. Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide. American Heart Journal. 2010 Jan 1;159(1):47-54. Epub 2009 Dec 16. doi: 10.1016/j.ahj.2009.10.032

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title = "Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction: A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide",

abstract = "Background Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this. Methods Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years). Results Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both). Conclusions The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI. ",

author = "Kirsten Kruszewski and Anne Scott and Barclay, {Justin Lee} and Small, {Gary Robert} and Croal, {Bernard L.} and Hillis, {Graham Scott}",

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T1 - Non-invasive assessment of left ventricular filling pressure following acute myocardial infarction

T2 - A prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide

AU - Kruszewski, Kirsten

AU - Scott, Anne

AU - Barclay, Justin Lee

AU - Small, Gary Robert

AU - Croal, Bernard L.

AU - Hillis, Graham Scott

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Background Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this. Methods Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years). Results Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both). Conclusions The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.

AB - Background Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this. Methods Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years). Results Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' >15, P < .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P < .001) and medium-term mortality (hazard ratio 4.67 for E/e' >15, P < .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P < .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio >15 identified a subgroup at greatest risk of mortality (P < .001 for both). Conclusions The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.

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