Usefulness of predischarge echocardiographic criteria in predicting complications following acute myocardial infarction.

In 103 patients who recovered from an acute myocardial infarction (AMI) we evaluated the usefulness of predischarge clinical, routine laboratory and M-mode echocardiographic (echo) criteria in predicting cardiac complications during a period of 12-41 months (25.0 +/- 10.7 months) follow-up. The echo parameters evaluated were: left ventricular diastolic diameter, left ventricular percent fractional shortening and the mitral valve E point septal separation. The combination of these three echo criteria was defined as an echo-index, which was considered abnormal if at least two of the three single parameters were pathological. Congestive heart failure occurred in 35 (34%) patients, with significantly higher prevalence among those older than 65 years, with previous AMI and with predischarge findings of heart failure. However, the sensitivity of these clinical parameters was unsatisfactory (34-69%). The sensitivity, specificity and positive predictive value of the echo-index for future heart failure were 89, 88 and 80%, respectively. Chest pain prior to hospital discharge was the only criteria predicting high risk of reinfarction (p = 0.001). The risk of cardiac death was related to age older than 65 years (p = 0.03) and an abnormal echo-index (p = 0.01). The overall mortality rate was 13%, but only 6% among those with normal and 26% among those with pathologic echo-index. In conclusion, in patients who recovered from an AMI, a simple and easily measured echo-index was superior to most clinical and routine laboratory criteria in predicting future heart failure and cardiac death.