LONG-TERM PROGNOSTIC-SIGNIFICANCE OF M-MODE ECHOCARDIOGRAPHY IN YOUNGMEN AFTER MYOCARDIAL-INFARCTION

Objective-To measurements and function for predicting long term (82 mo nth) mortality by performing echocardiography in 97 men who had surviv ed an acute myocardial infarction. Setting-University hospital special ising in cardiology. Participants-97 consecutive male patients who had survived a myocardial infarction. Main outcome measures-The additive prognostic value of functional measurements to that provided by primar y risk factors (smoking habits and lipoprotein levels), radiological h eart size, exercise capacity, and number of major coronary arteries wi th haemodynamically significant stenoses was evaluated. An echo index was calculated from three echocardiographic variables (yielding one sc ore point each if: left ventricular diameter at the end of diastole (L VDD) greater than or equal to 5.7 cm, left ventricular fractional shor tening less than or equal to 24%, and E point-separation (EPSS) greate r than or equal to 10 mm). Main outcome-17 cardiac deaths occurred dur ing follow up. Results-Univariate analysis showed that treatment with loop diuretics for heart failure (P < 0.01), LVDD (P < 0.01), left ven tricular diameter at the end of systole (LVDS) (P < 0.001), left atria l diameter of Clinical (P<0.001), fractional shortening (P< 0.05), and echo index (P<0.001) were all associated with cardiac death. Angiogra phically determined regional wall motion disturbances (P < 0.005) and angiographic ejection fraction (P < 0.001) were also associated with c ardiac death, as was the number of major coronary arteries with signif icant stenosis (P< 0.05). When all significant echocardiographic varia bles from univariate analysis were entered into Cox proportional hazar ds survival analysis, LVDS and left atrial diameter contributed indepe ndently to the prediction of cardiac death. If angiographic data were also entered into the model, the echo index made an independent contri bution to the prediction of cardiac death. Conclusions-Among young mal e patients with a previous myocardial infarction, a simple M mode echo cardiographic examination can identify high and low risk patients and improve the prediction of cardiac death made from clinical information , exercise test, chest x ray and angiographically determined ejection fraction.