PROGNOSTIC EVALUATION OF POSTMYOCARDIAL I NFARCTION PATIENTS BY 2-DIMENSIONAL, ECHOCARDIOGRAPHY, VENTRICULAR LATE POTENTIALS AND BAROREFLEXSENSITIVITY

Background. Although many variables are useful predictors of post-infa rction mortality, their predictive positive values are weak when appli ed individually. The aim of this study was to determine the prognostic value of the combination of left ventricular ejection fraction, ventr icular late potentials and baroreflex sensitivity. Patients and method s. We studied 69 consecutive post-infarction patients. On the day of t heir discharge from the coronary unit, all patients underwent a two-di mensional echocardiography, to determine the ejection fraction as well as a high resolution electrocardiogram to detect late potentials. To a subset of 49 patients was carried out to learn their baroreflex sens itivity. The patients were followed for 14 +/- 7 months and the follow ing cardiac end points were considered: sudden cardiac death, non sudd en cardiac death and non-fatal episodes of sustained ventricular tachy cardia or ventricular fibrillation. Results. There were 8 end points: 3 sudden cardiac deaths, 3 non sudden cardiac deaths and 2 succesfully resuscited sustained ventricular tachycardia episodes. The rate of fi brynolisis was 55%. An ejection fraction < 45%, the presence of late p otentials and a baroreflex sensitivity < 3.0 msec/mmHg were univariate d predictors with predictive positive values of 33%, 24% and 16%, resp ectively. When ejection fraction < 45%, late potentials and baroreflex sensitivity < 3.0 were combined, we found a significant increase in t he positive predictive value (50%). Conclusion. The combined determina tion of ejection fraction, ventricular late potentials and baroreflex sensitivity allows us to identify subset postinfarction patients with a high rate of cardiac complications.