Prediction of cardiac mortality after myocardial infarction: the role of maximal treadmill stress echocardiography.
Patients frequently undergo low-level exercise treadmill testing after acute myocardial infarction (MI) and, in the absence of inducible ischemia, a maximal test several weeks later. This study examines 203 patients who had 2-dimensional echocardiography before and after a maximal Bruce protocol exercise treadmill test performed 4 to 6 weeks after MI. The subjects were followed for a mean of 43 months (range 1 to 77 months). Predictors of cardiac mortality by multivariate or univariate analysis included an ejection fraction < or =40%, diabetes, age > or=70 years, and ischemia by exercise echocardiography but not by electrocardiography. Therefore, standard electrocardiographic monitoring during exercise treadmill testing 6 weeks after MI fails to predict cardiac mortality. The addition of pre-exercise and post-exercise treadmill stress echocardiography to readily available clinical parameters identifies those patients at greatest risk for cardiac death (resting ejection fraction < or=40%) and detects residual exercise-induced ischemia that may be of additional prognostic value.
Vasey
C G
CG
Asheville Cardiology Associates, PA, Asheville, NC 28802-7239, USA. charliev@avlcard.com
Usedom
J E
JE
Woodard
S M
SM
Bhapkar
M
M
Schwartz
T
T
Koch
G G
GG
D000368:Aged; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate