Echocardiographic evaluation of mitral E/e′ ratio, along with angiographic findings and B-type natriuretic peptide levels as prognostic indicators in patients with ST-elevation myocardial infarction: A prospective cross-sectional study.

Neeraj  Kumar; Ravi Vishnu  Prasad; Gautam  Kumar

doi:10.51168/sjhrafrica.v6i9.2066

Authors

Neeraj Kumar DM Resident, Department of Cardiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Ravi Vishnu Prasad Professor, Department of Cardiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Gautam Kumar Associate Professor, Department of Cardiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i9.2066

Keywords:

ST-Elevation Myocardial Infarction, B-type Natriuretic Peptide, Echocardiography, E/e′ Ratio, Coronary Angiography, Prognostic Indicator

Abstract

Background
The approach to risk assessment in ST-Elevation Myocardial Infarction (STEMI) has evolved with advancements in echocardiographic and biochemical markers. The mitral E/e′ ratio and B-type Natriuretic Peptide (BNP) levels, along with coronary angiographic findings, offer a multidimensional approach to prognosis.

Aim

To evaluate mitral E/e′ ratio, BNP levels, and angiographic findings as prognostic indicators in STEMI patients.

Methods

A prospective, cross-sectional study was carried out at IGIMS, Patna, over 12 months (June 2024–May 2025). Fifty patients aged above 40 years diagnosed with STEMI were enrolled and followed up for six months. Echocardiography (including E/e′ ratio), BNP levels, and coronary angiography were assessed within 24 hours of admission. Follow-ups were conducted at 1 week, 3 months, and 6 months. Data were analyzed using SPSS v26.0.

Results

The participants' average age was 62.9 ± 10.8 years, and 68% of them were men. Among the most prevalent comorbidities were dyslipidemia (74%), diabetes mellitus (50%), and hypertension (54%). From 13.08 ± 3.21 at admission, the mean mitral E/e′ ratio decreased to 12.48 ± 2.47 at 1 week, 12.34 ± 2.10 at 3 months, and 12.12 ± 1.22 at 6 months (p < 0.001). From 1012.7 ± 890.4 pg/mL at admission to 195.1 ± 81.3 pg/mL at 6 months, BNP levels demonstrated a comparable progressive decline. Higher E/e′ and BNP levels were associated with worse outcomes, and in-hospital mortality was 14%.

Conclusion

Mitral E/e′ ratio, BNP level, and angiographic profile are effective prognostic tools in STEMI. Their integration enhances early risk stratification and individualized patient management.

Recommendation

Routine incorporation of mitral E/e′ ratio and B-type Natriuretic Peptide assessment, along with angiographic evaluation, is recommended for comprehensive prognostic evaluation and management of patients with ST-Elevation Myocardial Infarction.

References

Roger V. Go AS Lloyd-Jones DM Benjamin EJ Berry JD Borden WB Bravata DM Dai S Ford ES Fox CS Fullerton HJ Gillespie C Hailpern SM Heit JA Howard VJ Kissela BM Kittner SJ Lackland DT Lichtman JH Lisabeth LD Makuc DM Marcus GM Marelli A Matchar DB Moy CS Mozaffarian D Mussolino ME Nichol G Paynter NP Soliman EZ Sorlie PD Sotoodehnia N Turan TN Virani SS Wong ND Woo D Turner MB. Heart disease and stroke statistics-2012 update: a report from the American Heart Association. Circulation. 2012;125:e2. https://doi.org/10.1161/CIR.0b013e31823ac046

Jayaraj JC, Davatyan K, Subramanian S, Priya J. Epidemiology of myocardial infarction. Myocardial Infarction: IntechOpen; 2018.

Rathore V, Singh N, Mahat RK, Kocak M, Fidan K, Ayazoglu T, et al. Risk factors for acute myocardial infarction: a review. Ejmi. 2018;2(1):1-7. https://doi.org/10.14744/ejmi.2018.76486

De Luca G, Suryapranata H, Marino P. Reperfusion strategies in acute ST-elevation myocardial infarction: an overview of current status. Progress in cardiovascular diseases. 2008;50(5):352-82. https://doi.org/10.1016/j.pcad.2007.11.004

Stătescu C, Anghel L, Tudurachi B-S, Leonte A, Benchea L-C, Sascău R-A. From classic to modern prognostic biomarkers in patients with acute myocardial infarction. International Journal of Molecular Sciences. 2022;23(16):9168. https://doi.org/10.3390/ijms23169168

Rigolli M, Rossi A, Quintana M, Klein AL, Yu C-M, Ghio S, et al. The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction: Can age-stratified E/A ratio alone predict survival? International Journal of Cardiology. 2015;181:362-8. https://doi.org/10.1016/j.ijcard.2014.12.051

York MK, Gupta DK, Reynolds CF, Farber-Eger E, Wells QS, Bachmann KN, et al. B-type natriuretic peptide levels and mortality in patients with and without heart failure. Journal of the American College of Cardiology. 2018;71(19):2079-88. https://doi.org/10.1016/j.jacc.2018.02.071

Tsutsui H, Isobe M, Ito H, Okumura K, Ono M, Kitakaze M, et al. JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure-digest version-. Circulation Journal. 2019;83(10):2084-184. https://doi.org/10.1253/circj.CJ-19-0342

Temporelli PL, Giannuzzi P, Nicolosi GL, Latini R, Franzosi MG, Gentile F, et al. Doppler-derived mitral deceleration time as a strong prognostic marker of left ventricular remodeling and survival after acute myocardial infarction: results of the GISSI-3 echo substudy. Journal of the American College of Cardiology. 2004;43(9):1646-53. https://doi.org/10.1016/j.jacc.2003.12.036

Giannuzzi P, Imparato A, Temporelli PL, de Vito F, Silva PL, Scapellato F, et al. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. Journal of the American College of Cardiology. 1994;23(7):1630-7. https://doi.org/10.1016/0735-1097(94)90667-X

Rørth R, Jhund PS, Yilmaz MB, Kristensen SL, Welsh P, Desai AS, et al. Comparison of BNP and NT-proBNP in patients with heart failure and reduced ejection fraction. Circulation: Heart Failure. 2020;13(2):e006541. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006541

Eitel I, Stiermaier T, Lange T, Rommel K-P, Koschalka A, Kowallick JT, et al. Cardiac magnetic resonance myocardial feature tracking for optimized prediction of cardiovascular events following myocardial infarction. JACC: Cardiovascular Imaging. 2018;11(10):1433-44. https://doi.org/10.1016/j.jcmg.2017.11.034

Bare L. 001 Sirolimus Eluting Stent And Unprotected Left Main Stenosis: The Multicenter E-Cypher Registry. Heart. 2005;91:A5-A72.