EVOLUTION OF ELECTROCARDIOGRAPHIC AND ECHOCARDIOGRAPHIC ABNORMALITIESDURING THE 4 YEARS FOLLOWING FIRST ACUTE MYOCARDIAL-INFARCTION

Therapies aimed at salvaging jeopardized myocardium in patients with a cute myocardial infarction (MI) are now routine. The success of these therapies must often be estimated by non-invasive rests, such as the 1 2-lead electrocardiogram (EGG) or. two-dimensional echocardiography. T o monitor QRS changes and left ventricular (LV) function over time in patients who have received therapies aimed at myocardial salvage, it i s important to know the 'spontaneous' evolution of these estimates. Co nsecutive MI survivors admitted in the pre-thrombolytic era with their first MI were re-studied at 4 years. Patients were excluded if they h ad experienced reinfarction, coronary revascularization or bundle bran ch block in the acute or follow-lip period. A standard ECG and a two-d imensional echocardiogram were obtained prior to discharge and at foll ow-up. The quantitative ECG analysis was performed according to the Se lvester QRS scoring method. During the two-dimensional echocardiogram each of the 20 segments of the LV were assessed to provide a wall moti on score. Eighty patients with a median age of 64 years (range 40-79) were included in the study. Thirty-two had anterior and 48 inferior MI . A significant decrement in median QRS score-estimated AMI size occur red between pre-discharge and follow-up ECGs in the entire group (18.3 % vs 10.5%; P < 0.00001). This difference occurred in both anterior (2 1.6% vs 10.5%; P < 0.00001) and inferior-posterior (16.5% vs 10.5%; P < 0.00001) MI locations. In the anterior MI group there was a trend re wards a greater total decrease of QRS points than in the inferior -pos terior MI group (42% vs 27%, P = 0.10). Within the anterior MI group, more QRS points awarded in the anteroseptal leads (V-1-V-3) remained a t follow-up than in the anterosuperior and apical leads (I, aVL and (V -4-V-6), (80% vs 49%; P = 0.03). Within the inferior-posterior MI grou p there were no significant differences in QRS point resolution betwee n lead groups. The comparison between pre-discharge and follow-up two- dimensional echocardiograms demonstrated a significant decrease in wal l motion scare in the population as a whole (median 9.4 vs 7.6; P = 0. 01). The same trend was found for both anterior (median 16.4 vs 14.8, P = 0.057) and inferior-posterior MI (7.5 vs 5.5, P = O.11). There was a significant correlation between the resolution of QRS score and the improvement in wall motion score (P = 0.04). In MI patients not treat ed with reperfusion therapies, without re-infarction or revascularizat ion during 4 years follow-up, a significant and parallel improvement i n ECG and two-dimensional echocardiographic indices of MI size occurs. These results can provide control data for evaluating the long-term b enefits of thrombolytic therapy.