Prognostic value of pre-discharge exertion echocardiography after acute myocardial infarct

• Published in: Revista española de cardiologia Vol. 51; no. 1; pp. 21 - 26
• Main Authors: González-Alujas, T, Armada, E, Alijarde, M, Evangelista, A, García del Castillo, H, Soler Soler, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.01.1998
• Subjects: Aged; Data Interpretation, Statistical; Diagnosis, Differential; Echocardiography; Evaluation Studies as Topic; Exercise Test; Follow-Up Studies; Humans; Middle Aged; Myocardial Infarction - diagnosis; Predictive Value of Tests; Prognosis; Sensitivity and Specificity; Time Factors
• ISSN: 0300-8932

The aim of the present work was to ascertain the usefulness of exercise echocardiography performed prior to discharge following acute non-complicated myocardial infarction in the prognosis and detection of multi-vessel disease. Sixty-five consecutive patients with primary episode of acute non-complicated myocardial infarction, with normal or slightly depressed ventricular function, were studied. Submaximal exercise test including echocardiogram pre- and immediately post-exercise were performed 7 to 10 days after infarction. Mean follow-up was 15 +/- 8 months; 15 patients presented angina, 9 revascularization and 1 died. Electrocardiographic ischaemia had low sensitivity and negative predictive value regarding complications (44% and 73% respectively); however, its specificity and positive predictive values were high (97% and 92%). In contrast, echocardiography-detected ischaemia showed much better sensitivity and negative predictive values (72% and 83%), with a slight decrease in specificity and positive predictive values (87% and 78%). Both remote ischaemia and the increase in global score > 0.25 during exercise were of high prognostic value (p < 0.001). Remote echocardiographic ischaemia yielded the diagnosis of multi-vessel disease with greater sensitivity than electrocardiographic ischaemia (84% vs 41%). Exercise echocardiography is highly useful in the prognostic assessment of patients prior to discharge following acute non-complicated myocardial infarction. The ischaemia detected on sub-maximal exercise and assessed by echocardiography was much more sensitive than that detected by electrocardiography in the prediction of new coronary events and multi-vessel disease.