PROGNOSIS OF PREDISCHARGE EXERCISE ECHOCARDIOGRAPHY IN ACUTE MYOCARDIAL-INFARCTION

Objective. The aim of the present work was to ascertain the usefulness of exercise echocardiography performed prior to discharge following a cute non-complicated myocardial infarction in the prognosis and detect ion of multi-vessel disease. Patients and methods. Sixty-five consecut ive patients with a primary episode of acute non-complicated myocardia l infarction, with normal or slightly depressed ventricular function, were studied. Submaximal exercise test including echocardiogram pre-an d immediately post-exercise were performed 7 to 10 days after infarcti on. Mean follow-up was 15 +/- 8 months; 15 patients presented angina, 9 revascularization and 1 died. Results. Electrocardiographic ischaemi a had low sensitivity and negative predictive value regarding complica tions (44% and 73% respectively); however, its specificity and positiv e predictive values were high (97% and 92%). In contrast, echocardiogr aphy-detected ischaemia showed much better sensitivity and negative pr edictive values (72% and 83%), with a slight decrease in specificity a nd positive predictive values (87% and 78%). Both remote ischaemia and the increase in global score > 0.25 during exercise were of high prog nostic value (p < 0.001). Remote echocardiographic ischaemia yielded t he diagnosis of multi-vessel disease with greater sensitivity than ele ctrocardiographic ischaemia (84% vs 41%). Conclusions. Exercise echoca rdiography is highly useful in the prognostic assessment of patients p rior to discharge following acute non-complicated myocardial infarctio n. The ischaemia detected on sub-maximal exercise and assessed by echo cardiography was much more sensitive than that detected by electrocard iography in the prediction of new coronary events and multi-vessel dis ease.