Exercise echocardiography can be used in the post-MI patient to assess the likelihood of significant coronary stenoses in the non-infarct vessels. However, little data exist concerning the significance of changes in wall motion in the infarct zone in the early post-MI setting. Purpose: To determine the ability of changes in infarct zone wall motion to predict infarct artery stenosis in patients undergoing pre-discharge exercise echocardiography. Methods: 32 patients underwent treadmill exercise testing with baseline and immediate post-exercise echocardiography a mean of 5 days post MI, with coronary arteriography documenting the status of the infarct artery (>70% = significant stenosis, 16 patients). Images were analyzed using a 16 segment model. Wall motion was graded as normal, hypokinetic, akinetic, dyskinetic for each segment, pre- and post-exercise. Wall motion changes in the infarct zone were characterized as A) no change, B) worsening = abnormal motion at rest, worsens post exercise only in those same segments, C) extension = normal segment in the infarct zone becomes abnormal, and D) (BOTH) worsening and extension. Groups B (n=6) and C (n=1) were combined. Sensitivity, specificity, and positive predictive value (PPV) of changes in infarct zone wall motion for a stenosed infarct artery were calculated. Results: #pts Sens Spec PPV No change 18 67% 33% 33% Worsening or extension 7 25% 81% 57% Both 7 38% 94% 86% Conclusion: The use of pre-discharge exercise echocardiography for determining the patency of the infarct artery is limited. No change in wall motion is seen in 1/3 of patients with significant stenoses, and worsening of infarct zone wall motion is seen in almost 1/3 of patients with patent arteries. Only worsening plus extension of abnormal wall motion within the infarct zone is highly predictive of a stenosed infaract artery.
|Number of pages||1|
|Journal||Journal of the American Society of Echocardiography|
|State||Published - 1997|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine