SERIAL DOPPLER-ECHOCARDIOGRAPHY IN EARLY DIAGNOSIS OF LEFT-VENTRICULAR DYSFUNCTION AFTER ACUTE MYOCARDIAL-INFARCTION

The prognosis of acute myocardial infarction depends on the developmen t of left-ventricular dilatation and chronic heart failure. Serial ech ocardiography was performed on admission and on days 2, 4 and 6, to di scover the temporal course of any early myocardial adaptation. There w ere 78 patients (20 women, 58 men; mean age 59 [49-69] years) with acu te myocardial infarction and systemic thrombolysis, first studied up t o 4 hours after onset of symptoms. The patients were divided into two groups according to infarct size as measured by creatine kinase (>>are a under the curve<< - AUC); group 1: CK AUC < 12 IU/ml h; group 2: CK AUC > 12 IU/ml h. While there was no difference between the two groups on admission and on day 2, filling patterns differed significantly at the end of the first postinfarction week in that maximal early diasto lic flow velocity (E) in group 1 was 0.65 m/s, but 0.73 m/s in group 2 (P <0.05); maximal late diastolic flow velocity (A), group 1: 0.71, g roup 2: 0.58 m/s (P <0.01); E/A ratio: 0.89 vs 1.22 (P <0.001); integr ated E/A ratio 1.37 vs 1.77 (P <0.001), and the atrial component of le ft-ventricular filling 42 vs 36% (P <0.001). - It is concluded that th e serial measurement of left-ventricular filling by Doppler echocardio graphy in the first post-infarction week can identify patients with im paired left-ventricular function through differences in flow pattern. Drug or interventional treatment can then be started early to prevent further left-ventricular dilatation and in this way improve prognosis.