title: Prognostic use of echocardiography 1 year after a myocardial infarction.
abstract: BACKGROUND
  Left ventricular (LV) and right ventricular (RV) function are known predictors of morbidity and mortality after an acute myocardial infarction (MI). However, the prognostic use of a late evaluation of cardiac function after an MI remains unclear.
  
  
  METHODS
  We analyzed echocardiograms obtained 1 year after MI in patients with LV dysfunction at baseline (ejection fraction [EF] < or = 40%) from 291 patients enrolled in the SAVE echocardiographic substudy who did not develop heart failure (HF) or a recurrent MI during this first year. Left ventricular EF and RV fractional area change were assessed.
  
  
  RESULTS
  After a median follow-up of 22 months after the 1-year echocardiogram, a low LVEF (< 30%) at 1 year was associated with an increased risk of death and/or HF (hazards ratio [HR] 2.7, 95% CI 1.3-5.3). Presence of RV dysfunction was also associated with an increased risk of death (HR 8.9, 95% CI 3.5-22.1), development of HF (HR 7.1, 95% CI 3.4-15.0), and the composite end point of death or HF (HR 7.6, 95% CI 4.1-14.2). In multivariate analyses, both low LVEF and RV dysfunction remained independently predictive of the composite end point of death or HF. Patients with biventricular dysfunction were at the greatest risk of death and/or HF (HR 19.4, 95% CI 8.2-46.0) in follow-up.
  
  
  CONCLUSIONS
  In a stable population of survivors of MI, impaired LV and RV function at 1 year after MI are independently and additively predictive of increased risk of HF or death.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.forename: Leonardo A M
authors.initials: LA
authors.lastname: Zornoff
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Malcolm O
authors.initials: MO
authors.lastname: Arnold
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Lemuel A
authors.initials: LA
authors.lastname: Moyé
authors.forename: Ted
authors.initials: T
authors.lastname: Plappert
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Sussex
authors.forename: Martin
authors.initials: M
authors.lastname: St John Sutton
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D013997:Time Factors; D014463:Ultrasonography; D016276:Ventricular Function