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Prognostic value of predischarge 2-dimensional echocardiogram after acute myocardial infarction
Insights
A 2-dimensional echocardiogram (2-D echo) can predict complications after myocardial infarction (MI). A higher wall motion score index (WMSI) on 2-D echo indicates increased risk of adverse events post-MI.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Prognosis
Background:
- Acute myocardial infarction (MI) survivors face risks of future complications.
- Early risk stratification is crucial for managing post-MI patients.
- Two-dimensional echocardiography (2-D echo) is a standard imaging technique.
Purpose of the Study:
- To evaluate the prognostic value of 2-D echo in patients surviving acute myocardial infarction.
- To determine if wall motion abnormalities assessed by 2-D echo predict adverse outcomes.
- To establish the utility of the wall motion score index (WMSI) for risk stratification.
Main Methods:
- 46 acute myocardial infarction survivors underwent 2-D echo 10-15 days post-MI.
- A 14-segment left ventricular model was used to calculate the wall motion score index (WMSI).
- Patients were followed for a mean of 21 months for complications (death, re-MI, heart failure, angina).
Main Results:
- 17 patients (37%) experienced complications during follow-up.
- Patients with complications had a significantly higher WMSI (2.2 ± 0.4) compared to those without (1.7 ± 0.5).
- The WMSI showed prognostic value in identifying patients at higher risk for adverse events post-MI.
Conclusions:
- 2-D echo derived WMSI is a valuable prognostic tool in acute myocardial infarction survivors.
- Elevated WMSI predicts a higher likelihood of complications, including heart failure and angina.
- This non-invasive assessment aids in identifying high-risk patients for closer monitoring and management.
Abstract:
The prognostic value of a 2-dimensional echocardiogram (2-D echo) was determined in 46 patients (32 men and 14 women) who survived an acute myocardial infarction (MI) from November 1979 to December 1980. The mean age of the patients was 61 years (range 36 to 92). The MI was anterior in 21, inferior in 22 and indeterminate in 3; it was transmural in 31 and nontransmural in 15. A 2-D echo was obtained 10 to 15 days after the MI--that is, 1 to 3 days before hospital discharge. A wall motion score index (WMSI) was derived with the use of a 14-segment model of the left ventricle. Each segment was assigned a number corresponding to its wall motion (0 = hyperkinetic, 1 = normal, 2 = hypokinetic, 3 = akinetic, 4 = dyskinetic and 5 = aneurysm) and the WMSI was calculated by dividing the sum of these numbers by the number of segments visualized (1.0 = normal wall motion). During a mean follow-up of 21 months (range 15 to 28), 17 patients had a complication: death, recurrence of MI, congestive heart failure of New York Heart Association class III or IV, or angina graded New York Heart Association class III or IV. Patients with compared to those without complications had a significantly higher WMSI (2.2 +/- 0.4 and 1.7 +/- 0.5, p less than 0.005). The difference in WMSI between those who died and those who survived was not significant because of the small number of deaths.(ABSTRACT TRUNCATED AT 250 WORDS)