Predictive value of pulsed Doppler echocardiography in acute myocardial infarction.

In 60 consecutive patients with acute myocardial infarction early Doppler echocardiographic measurements of ventricular systolic and diastolic function were obtained and correlated with the degree of heart failure during the subsequent clinical course. Transmitral flow (early to atrial peak flow velocity ratio [E/A], systolic function measurements (maximal velocity at aortic anulus level [Vmax]), and time velocity integral (TVI) were obtained, as well as an "outflow tract ratio" (OTR), that is, measurement of the functional length of the left ventricular outflow tract. Spatial apical flow pattern was assessed with the sample volume positioned near the lateral wall and interventricular septum and by the simultaneous recording of apical and transmitral flow with a high pulse repetition frequency. Mean values of both E/A and systolic measurements of the entire group were used as cutoff values to identify patients with absent or mild heart failure defined as Killip I and II. E/A greater than 0.96 had a low specificity (45%) and positive predictive value (70%). Systolic function: Vmax greater than 0.66 m/sec, TVI greater than 12.6 cm, and OTR less than 0.48 had a specificity of 86%, 93%, and 93%, respectively, and a positive predictive value of 91%, 96%, and 96%. Normal spatial apical flow patterns demonstrated a specificity of 84% and positive predictive value of 91% to identify patients with infarctions who have a subsequent mild clinical course. Thus in contrast to E/A, both systolic function measurements and spatial apical flow patterns may identify on admission patients with a subsequent mild clinical course.