Prognostic implications of reduction of left ventricular filling pressure in early transmural acute myocardial infarction.

The left ventricular filling pressure (LVFP) was measured within 12 hours of onset of acute myocardial infarction (AMI) in 99 patients, including 21 nonsurvivors. Initial LVFP for survivors was 18 +/- 6 mm Hg (mean +/- SD) and for nonsurvivors was 24 +/- 8 mm Hg (p less than 0.005). Of the total population, 87% had initial LVFP of 12 mm Hg or greater and all nonsurvivors were in this group. Life table analysis was employed to determine LVFP related mortality rates. If initial LVFP was less than or equal to 18 mm Hg, 72-hour mortality rate was 4% and 30-day mortality rate was 10%. For initial LVFP greater than 18 mm Hg, 72-hour mortality rate was 21% and 30-day mortality rate was 33% (p less than 0.005 for both 72 hours and 30 days). When final LVFP was analyzed 30-day mortality rate for final LVFP less than or equal to 18 mm Hg was 5%. Mortality rate of 60% was observed for final LVFP greater than 18 mm Hg. We compared sequential measurements of LVFP in a subset of survivors and nonsurvivors and observed that long-term average trend was for survivors to decrease their LVFP. We conclude that AMI mortality rate is related to LVFP and that LVFP greater than 18 mm Hg is associated with very high mortality rate when compared to LVFP less than or equal to 18 mm Hg. Thus reduction of LVFP either spontaneously or as result of therapy may lower AMI mortality rate.