[Prognostic value of pre-discharge exertion echocardiography after acute myocardial infarct].
OBJECTIVE
The aim of the present work was to ascertain the usefulness of exercise echocardiography performed prior to discharge following acute non-complicated myocardial infarction in the prognosis and detection of multi-vessel disease.


METHODS
Sixty-five consecutive patients with primary episode of acute non-complicated myocardial infarction, with normal or slightly depressed ventricular function, were studied. Submaximal exercise test including echocardiogram pre- and immediately post-exercise were performed 7 to 10 days after infarction. Mean follow-up was 15 +/- 8 months; 15 patients presented angina, 9 revascularization and 1 died.


RESULTS
Electrocardiographic ischaemia had low sensitivity and negative predictive value regarding complications (44% and 73% respectively); however, its specificity and positive predictive values were high (97% and 92%). In contrast, echocardiography-detected ischaemia showed much better sensitivity and negative predictive values (72% and 83%), with a slight decrease in specificity and positive predictive values (87% and 78%). Both remote ischaemia and the increase in global score > 0.25 during exercise were of high prognostic value (p < 0.001). Remote echocardiographic ischaemia yielded the diagnosis of multi-vessel disease with greater sensitivity than electrocardiographic ischaemia (84% vs 41%).


CONCLUSIONS
Exercise echocardiography is highly useful in the prognostic assessment of patients prior to discharge following acute non-complicated myocardial infarction. The ischaemia detected on sub-maximal exercise and assessed by echocardiography was much more sensitive than that detected by electrocardiography in the prediction of new coronary events and multi-vessel disease.
González-Alujas
T
T
Servicio de Cardiología, Hospital General Universitario Vall d'Hebron, Barcelona.
Armada
E
E
Alijarde
M
M
Evangelista
A
A
García del Castillo
H
H
Soler Soler
J
J
D000368:Aged; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D004452:Echocardiography; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D013997:Time Factors
Valor pronóstico de la ecocardiografía de esfuerzo postinfarto agudo de miocardio antes del alta hospitalaria.