Heart failure after myocardial infarction: the importance of diastolic dysfunction. A prospective clinical and echocardiographic study.

Clinical signs of heart failure based on predefined criteria were analysed in 217 survivors (< 75 years of age) of an acute myocardial infarction (AMI). A Doppler investigation and M-mode echocardiography were performed 3-5 days after the index infarction. All patients were stratified according to left ventricular end-diastolic diameter </> or = 28 mm.m-2 body surface area. Fractional shortening, E-point septal separation, Keren's echo-index based on left ventricular end-diastolic diameter, fractional shortening and E-point septal separation were used as indices of systolic function, and the E/A ratio and isovolumic relaxation time as indices of diastolic function. Fifty-one per cent of the patients (n = 111) had heart failure. Left ventricular end-diastolic diameter was < 28 mm.m-2 body surface area in 32 (29%) of the heart failure patients and in 44 (45%) of those without heart failure. An abnormal Keren's echo-index was found in 58 (52%) of the heart failure patients compared with 17 (18%) without heart failure. The E/A ratio was lower (0.65 vs 0.77, P = 0.01) in heart failure patients with a normal left ventricular end-diastolic diameter compared with patients without heart failure and a normal left ventricular end-diastolic diameter. Infarct size, E-point septal separation, heart rate and age were determinants of heart failure in multivariate analyses with all patients included. Infarct size and the E/A ratio were determinants of heart failure in patients with a normal left ventricular end-diastolic diameter.(ABSTRACT TRUNCATED AT 250 WORDS)