SIGNIFICANCE OF PROLONGED LEFT-VENTRICULAR WALL-MOTION ABNORMALITIES AFTER EXERCISE ECHOCARDIOGRAPHY FOLLOWING NON-Q-WAVE ACUTE MYOCARDIAL-INFARCTION

Exercise echocardiography was used to assess myocardial ischemia after non-Q-wave acute myocardial infarction in 40 consecutive patients. Re sting parasternal long-and short-axis views and apical 4- and 2-chambe r views were recorded, digitized, and stored, A maximal symptom-limite d exercise test was performed within 21 days (mean 17.7 +/- 3) using a cycle ergometer with continuous monitoring and the echocardiogram was repeated in the same views. Resting and exercise echocardiograms were then compared. Coronary angiography was performed in all patients wit hin 21 days of exercise echocardiography. Stenosis in greater than or equal to 50% of the lumen diameter was considered significant Of the 4 0 patients studied, 29 (72%) had continuing angina and 11 (28%) had no angina. Eighteen patients (62%) with angina developed angina during e xercise testing and 19(65%) developed ST-segment depression, In patien ts without angina, 1 (9%) developed postexercise angina and 2 (18%) de veloped ST-segment depression. The mean wall motion score index after exercise increased from 1.2 +/- 0.3 to 1.8 +/- 0.4 in patients with co ntinuing angina (p <0.001) and from 1.2 +/- 0.3 to 1.4 +/- 0.3 in pati ents without angina (p = NS). Prolonged wall motion abnormalities last ing >20 minutes persisted in greater than or equal to 1 segment in 27 of 29 patients (93%) with angina or in 2 of 11 patients (18%) without angina (p <0.001), Patients with continued angina had predominantly 3- vessel coronary artery disease (22 of 29 [76%]) or 2-vessel disease (7 of 29 [24%]), and those without angina had 1-vessel disease (6 of 11 [55%]) or 2-vessel disease (4 of 11 [36%]). One patient had 3-vessel d isease. The duration of wall motion abnormality demonstrated a signifi cant relation to 2- and 3-vessel coronary artery disease (p <0.001). T hus, patients with non-Q-wave acute myocardial infarction had a high i ncidence of multivessel coronary disease not necessarily detected on r outine exercise testing. There was also a significant incidence of pro longed wall motion abnormality. (C) 1997 by Excerpta Medica, Inc.