02132nas a2200217   4500000000100000008004100001100001800042700001300060700001500073700001300088700001000101700001800111700001500129700001300144245022700157250001500384300001000399490000800409520145100417020004601868       2010                            d1 aKruszewski K.1 aScott A.1 aBarclay J.1 aCroal B.1 aOh J.1 aHillis Graham1 aMøller J.1 aSmall G.00aNoninvasive assessment of left ventricular filling pressure after acute myocardial infarction: a prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide  a2010/01/28  a47-540 v1593 a<p>
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'&gt;15, P &lt; .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P &lt; .001) and medium-term mortality (hazard ratio 4.67 for E/e'&gt;15, P &lt; .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P &lt; .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio &gt;15 identified a subgroup at greatest risk of mortality (P &lt; .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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