Iwahashi et al used two echocardiographic ratios to evaluate a patient following a first-time ST elevation myocardial infarction (STEMI). This can help to identify a patient who may benefit from more aggressive management. The authors are from Yokohama City University Medical Center.


Patient selection: first-time STEMI with reperfusion


Outcomes: cardiac death or heart failure


Echocardiographic parameters measured at 2 weeks after the STEMI (based on units in Table 2):

(1) peak E-wave transmitral flow velocity in cm/s (E)

(2) early diastolic velocity at the mitral valve annulus in m/s (e’)

(3) peak A-wave transmitral flow velocity (late diastolic wave velocity of mitral inflow) in cm/s (A)


E to e’ ratio =

= (E velocity) / (e’ velocity)


transmitral (TM) E/A ratio =

= (E velocity) / (A velocity)



• The units for E and e' differ. Units described in Table 2 page 1293..


Risk factors for poor prognosis:

(1) E/e’ ratio > 15

(2) TM-E/A ratio > 1.0


An additional risk factor found on multivariate analysis was a BNP > 180 pg/mL (method TOSOH Corporation).


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