Immediate detection of early high-risk patients with acute myocardial infarction using two-dimensional echocardiographic evaluation of left ventricular regional wall motion abnormalities.

Forty-three patients with acute myocardial infarction (AMI) were studied with serial two-dimensional echocardiography (2DE) to define a high-risk subset for in-hospital cardiovascular complications including pump failure, life-threatening arrhythmias, or death. A 2DE segment score was developed representing the extent of left ventricular (LV) regional wall motion abnormality (WMA) which was correlated with peak total creatine kinase (CK) release. Patients with transmural AMI had a segment score of 7.2 +/- 3.8, whereas those with nontransmural AMI had a segment score of 4.7 +/- 3.4 (p less than 0.025). Peak total serum CK enzyme level correlated statistically with segment score but with a low correlation coefficient. Thirteen (30%) of the 43 patients had an in-hospital complication and their segment score was 10.0 +/- 3.4 compared to 4.6 +/- 2.7 in those patients without a complication (p less than 0.005). A segment score greater than or equal to 8 was found in 11 of 13 (85%) of those who suffered a cardiac complication and in only five (16%) of the 30 patients without complication (p less than 0.05; sensitivity 85%, specificity 83%). Patient's initial clinical Killip classification was specific but very insensitive in predicting an early complicated course. Thus, 2DE study of LV regional wall motion can predict in the immediate post-AMI stage the in-hospital likelihood of such patients developing a cardiovascular complication during acute myocardial infarction.