ROLE OF STRESS ECHOCARDIOGRAPHY IN RISK STRATIFICATION EARLY AFTER ANACUTE MYOCARDIAL-INFARCTION

Resting and stress echocardiography is a 'one-stop shop', which enable s a wide range of information to be collected on resting function. myo cardial viability, and induced ischaemia, all of which are useful for prognostic stratification. Large scale, multicentre, prospectively col lected data show the prognostic failure of resting function and induci ble ischaemia, both independently and combined, which are especially e ffective in predicting cardiac death. The GISSI data show that the inc rement of risk as a result of reduction in ventricular function has a hyperbolic trend, with a relatively moderate increase in mortality for ejection fraction values between 50 and 30%, but with marked increase s below 30%. The EPIC data show that the 1-year risk of cardiac death is as low as 2% in patients with negative dipyridamole stress echocard iography: it doubles if the test is positive at a high dose, and is al most four times higher if it is positive at a low dose. In the field o f prognostic stratification, in the absence of carefully controlled st udies, the choice between coronary angiography as the only essential s tudy, or use of a noninvasive test to discriminate access to catheteri zation currently reflect alternate philosophical approaches rather tha n scientifically based decisions. In the invasive approach, stress ech ocardiography offers relief from the vicious circle of chest pain-coro nary angiography-revascularization. In the non-invasive and physiologi cal approach, stress echo is capable of offering, in one sitting, an i nsight into the main determinants of survival: function, viability, an d ischaemia.