ADVANTAGES OF IMMEDIATE 2-DIMENSIONAL ECHOCARDIOGRAPHY IN PATIENTS WITH ACUTE CARDIAC ISCHEMIC EVENTS

We hypothesized that the assessment of kinetic alterations on two dime nsional echocardiogram (2DE) would provide greater diagnostic informat ion than clinical symptoms and ECG changes only. The study was aimed t o determine sensitivity of 2DE in patients with cardiac ischemic event s and to improve the indications to thrombolysis. Three-hundred ninety -one patients (87 F; 304 M) hospitalized for suspected acute myocardia l infarction (AMI), first episode, within 4 h from the onset of sympto ms, suitable for thrombolysis Killip class I-II and with unstable angi na (UA), were admitted in the study. Patients had to show ECG changes and alterations of segmentary motion on 2DE performed at entry, or 2DE alterations without ECG changes. The 2DE variables analyzed included right ventricular function and left ventricular systolic function. Thr ombolysis was performed when 2DE and ECG changes were evidenced at the same time and when 2DE alterations without ECG changes were observed. Patients with UA treated with heparin alone were also studied. The pr esence of segmentary motion alterations was mandatory. Results: Inferi or AMIs, 87 patients (60 +/- 13 years), anterior AMI, 169 patients (61 +/- 11 years); UA group subjected to thrombolysis, 87 patients (62 +/ - 12 years); UA group treated with heparin, 48 patients (62 +/- 12 yea rs). We noted only one patient false negative, and five patients false positive. Alterations of right ventricular function were observed in 24, 14 and nine patients with inferior, anterior AMI and UA, respectiv ely. Normal ECG at entry was observed in seven, two and seven patients with inferior, anterior AMI and UA, respectively. ST-segment depressi on was observed in nine and 19 patients with inferior and anterior AMI respectively. Sensitivity, specificity and test accuracy were 99%, 96 % and 98%, respectively. 2DE allows us to avoid the possibly harmful a djuvant therapies during the acute phases of cardiac ischemic events.