[Significance of early echocardiography in acute myocardial infarct]

The authors examined the role of echocardiography performed in the acute phase of the myocardial infarction, within 72 hours after hospitalization in order to reveal the diagnosis, to detect of the complications and mortality in hospital. 512 consecutive patients were examined by echocardiography. All of them were younger than 70, and they were treated at our department between 1st January, 1991 and 31st December, 1994 with acute myocardial infarction. In 34 cases the infarction was without Q wave. The most severe left ventricular wall motion abnormality was dyskinesis in 53, akinesis in 390, hypokinesis in 49 cases, normokinesis was detected in 20 patients. The detection of the wall motion abnormality helped to diagnose 27 right ventricular infarctions, 58 reinfarctions and 21 acute myocardial infarction with left bundle branch block. 43 patients (8.4%) died during the treatment. In all cases the pathological examination verified the diagnosis of the acute myocardial infarction, and at 4 patients free wall rupture had been revealed. Among the deceased left ventricular dilatation (16/43 versus 75/469, p < 0.001), ejection fraction lower than 40% (14/43 versus 52/469, p < 0.001), left ventricular wall motion abnormality index (16 segments; 1 = normokinesis, 2 = hypokinesis, 3 = akinesis, 4 = dyskinesis, 5 = aneurysm) higher than 2.0 (27/43 versus 93/469, p < 0.001), dyskinesis (12/43 versus 41/469, p < 0.001), pericardial effusion thicker than 5 mm (7/43 versus 31/469, p < 0.05), and right ventricular infarction (6/43 versus 21/469, p < 0.05) occurred significantly more often. Dyskinesis is a bad prognostic factor even in the case of good left ventricular function. According to the opinion of the authors, echocardiography performed at the early stage of acute myocardial infarction, increases the safety of the diagnosis and calls the attention to the patients with high risk.