Association Between the Mitral Annular E/e′ Ratio and In-Hospital Mortality in Acute ST-Elevation Myocardial Infarction: A Prospective Observational Study

TL;DR

This study shows that a high E/e′ ratio measured early after heart attack admission is strongly linked to higher in-hospital death rates.

Contribution

The study demonstrates the independent prognostic value of early E/e′ ratio in predicting in-hospital mortality in STEMI patients.

Findings

77 patients (30%) had an elevated E/e′ ratio (>15), associated with increased in-hospital mortality.

Elevated E/e′ was independently linked to in-hospital mortality after adjusting for other factors.

E/e′ ratio and Killip class together improve early risk assessment in STEMI patients.

Abstract

Background

Left ventricular (LV) diastolic dysfunction and elevated LV filling pressures are associated with adverse outcomes after acute ST-elevation myocardial infarction (STEMI). The tissue Doppler-derived mitral annular E/e′ ratio provides a simple, noninvasive estimate of LV filling pressure; however, its prognostic value when measured early after admission remains unclear. This study evaluated the association between early mitral annular E/e′ ratio and in-hospital mortality in patients with acute STEMI.

Materials and methods

In this prospective observational study, 256 consecutive patients admitted with acute STEMI underwent transthoracic echocardiography with tissue Doppler imaging within 24 hours of admission. Mitral inflow velocities (E, A), mitral annular early diastolic velocity (e’), and E/e’ ratio were measured. Patients were followed until hospital discharge. The primary endpoint of the study was all-cause in-hospital mortality.

Results

Seventy-seven patients (30%) had an elevated E/e’ ratio (>15), suggestive of increased LV filling pressures. In-hospital mortality was significantly higher in patients with E/e’ >15 compared with those with E/e’ ≤15 (34% vs. 4%, p = 0.002). Elevated E/e’ was also associated with reduced LV ejection fraction and abbreviated deceleration time. After multivariable analysis, E/e′ >15 and Killip class ≥II at admission were independently associated with in-hospital mortality.

Conclusions

An elevated mitral annular E/e′ ratio measured within 24 hours of admission is strongly and independently associated with in-hospital mortality in acute STEMI. Together with the Killip class, E/e′ offers complementary prognostic information and may enhance early bedside risk stratification.