The clinical value of mitral A-wave deceleration time in the prediction of a long-term adverse outcome in patients with myocardial infarction.

Introduction: Mitral A-wave deceleration time (Adt) is a promising Doppler parameter for the evaluation of left ventricular (LV) diastolic function. The aim of the present study was to investigate the long-term prognostic value of Adt in relation to the development of heart failure and cardiac death in the setting of the first acute myocardial infarction (MI).

Methods: Conventional Doppler echocardiographic study and Adt measurements were performed in 105 patients (age 60 +/- 10 years, 77 men) 8.07 +/- 0.96 days post MI. Patients were divided into three groups according to Adt duration: group 1 with Adt > or =70 ms, group 2 with 70 ms < Adt <115 ms, and group 3 with Adt > or =115 ms.

Results: Patients of groups 1 (Adt: 64 +/- 5 ms, n=11) and 3 (Adt: 123 +/- 8 ms, n=38) presented characteristics of restrictive physiology or impaired relaxation, respectively, while patients of group 2 (Adt: 92 +/- 9 ms, n=56) had near to normal LV filling characteristics. Patients were followed up for a mean of 44.7 months. Heart failure was found in 4 patients (36%) in group 1 and 6 (16%) in group 3, whereas the patients in group 2 were free of heart failure. Cardiac death occurred in 4 patients (36%) in group 1, 3 (7.9%) in group 3 and 2 (3.6%) in group 2. Kaplan-Meier survival curves indicated that patients with Adt < or =70 ms or Adt > or =115 ms had more frequent cardiac events and a significantly shorter event-free survival period in comparison with those with 70 ms < Adt < 115 ms (p = 0.0017). Cox analysis showed that Adt < or =70 ms (p = 0.002), Adt > or =115 ms (p = 0.02), restrictive LV filling pattern (p = 0.003), anterior wall MI (p = 0.02), ejection fraction (p = 0.03), age (p = 0.04), and treatment with angiotensin converting enzyme inhibitors (p = 0.009) were independent predictors of outcome.

Conclusions: Adt appears to be a strong and independent predictor of heart failure or cardiac death following a MI. A shortened Adt < or =70 ms is associated with higher rates of both cardiac death and heart failure, while a prolonged Adt > or =115 ms is associated with heart failure only.