054: Additive prognostic value of elevated left ventricular filling pressure during non ST elevation acute coronary syndrome

Myocardial ischemia during acute coronary syndromes (ACS) without ST segment elevation is responsible for diastolic dysfunction. The aim of our study is to evaluate LVFP in patients suffering from an ACS without ST segment elevation and to appreciate the additive prognostic value of this parameter beside the Global Registry of Acute Coronary Events (GRACE) score and the left ventricular ejection fraction (LVEF). This strategy may lead to a better risk stratification in this population.MethodsWe performed a prospective study in 220 patients admitted to our coronary care unit for ACS without ST segment elevation from January 2007 to September 2008. Risk score stratification using the GRACE score and assessment of systolic and diastolic functions by echocardiography was performed in all patients. LVFP was estimated by the E/e’ ratio and the difference between Ap and Am.ResultsThe mean age was 58 years with a sex ratio of 4.3. Hypertension, diabetes and dyslipidemia were present in 45%, 45% and 32.2% of cases respectively. The mean body-mass index was 26.1kg/m2. In-hospital mortality was 1.84%. After 2-years follow up, the survival rate was 92.16% with an event-free survival rate of 71.9%. In our population, elevated LVFP was found in 32.3% of cases mainly in elderly (p=0.007), diabetic (p=0.041), patients with hypertension (p<0.001), with a history of myocardial infarction (p<0.001) and in Killip 3 or 4 class (p<0.001). Chronic kidney disease and anemia were also found predictive of elevated LVFP (p values of 0.007 and 0.016 respectively). An intermediate or high GRACE score and LVEF< 45% are predictive of poor prognosis. The additive prognostic value of LVFP was calculated and confirmed in our study. In fact E/e’ ratio>15 improve the prognostic value of the combination of the GRACE score and LVEF with a chi2 value of 54.74.ConclusionOur study confirms the additive prognostic value of LVFP in addition to the GRACE risk score and LVEF in patients admitted for ACS without ST segment elevation