Does stress echocardiography add incremental value to baseline ejection fraction for the early identification of candidates for implantable defibrillators?
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Updated: Jan 21, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Josephine Muhrbeck1, Elif Gunyeli1, Eva Andersson1
1Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Insights
Reduced left ventricular ejection fraction (EF) after acute myocardial infarction (AMI) indicates sudden cardiac death risk. Baseline EF before discharge can predict which patients may need an implantable cardioverter defibrillator (ICD).
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Electrophysiology
Background:
- Reduced left ventricular ejection fraction (EF) after acute myocardial infarction (AMI) is a key predictor of sudden cardiac death.
- Current guidelines suggest considering implantable cardioverter defibrillator (ICD) therapy for patients with EF ≤35% at 6-12 weeks post-AMI.
Purpose of the Study:
- To determine if stress echocardiography performed early after AMI can identify patients who will meet ICD criteria before hospital discharge.
- To assess the predictive value of baseline and stress echocardiography parameters for long-term recovery of EF.
Main Methods:
- A prospective cohort study involving 96 patients with EF ≤40% early after AMI.
- Baseline and stress echocardiography were performed before discharge, with follow-up echocardiography at 3 months.
- Measurements included EF, mitral annular plane systolic excursion (MAPSE), and peak systolic velocity (PSV).
Main Results:
- Of 80 patients completing follow-up, 32 (40%) met ICD criteria (EF ≤35%) at 3 months.
- Patients who met ICD criteria had significantly lower baseline and stress EF, MAPSE, and PSV compared to those who recovered.
- Baseline EF demonstrated the highest predictive value (AUC 85%) for non-recovery; stress echocardiography provided no additional benefit.
Conclusions:
- Lower baseline and stress echocardiography parameters (EF, MAPSE, PSV) before discharge predict the need for ICD therapy in post-AMI patients.
- Stress echocardiography does not enhance the prediction of non-recovery compared to baseline EF alone.
Objective:
A reduction in left ventricular ejection fraction (EF) remains the strongest indicator of increased risk of sudden cardiac death after an acute myocardial infarction (AMI). Guidelines recommend that patients with an EF ≤35%, 6-12 weeks after AMI should be considered for implantable cardioverter defibrillator (ICD) therapy. Stress echocardiography is a safe method to detect viability in a stunned myocardium. The purpose of this study was to investigate if stress echocardiography early after AMI could identify ICD candidates before discharge.
Methods:
Ninety-six patients with EF ≤40% early after AMI were prospectively included in a cohort study, and investigated by baseline and stress echocardiography before discharge. Follow-up echocardiography was performed after 3 months. EF, mitral annular plane systolic excursion (MAPSE) and peak systolic velocity (PSV) were determined for each examination.
Results:
There were 80 (83%) patients who completed the baseline, stress and follow-up echocardiography. Among them there were 32 (40%) patients who met the ICD criteria of EF ≤35% at 3 months. For these patients, EF, MAPSE and PSV were significantly lower than for those patients who recovered. The area under the receiver operating characteristic curve (AUC) was 85% (95% CI 0.74 to 0.94) for baseline EF to predict non-recovery. None of the other variables had a higher AUC.
Conclusion:
Patients who met the ICD criteria of EF ≤35% at 3 months after myocardial infarction had lower EF, MAPSE and PSV on baseline and stress echocardiograph before discharge. Stress echocardiography did not add additional value in predicting non-recovery.
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