Left ventricular function of survivors of a first complicated acute myocardial infarction. A prehospital discharge cross-sectional echocardiographic study.

To assess the left ventricular function of patients who suffer from post-infarction angina and left ventricular failure in the coronary care unit, 79 consecutive survivors (mean age 48 years) of a first acute myocardial infarction were prospectively studied and followed-up for a mean 18- (10-34) month period. Forty-seven had an uncomplicated infarction, 17 suffered from post-infarction angina and 15 had left ventricular failure. The left ventricular function of these patients prior to discharge from hospital was assessed by cross-sectional echocardiography and radionuclide angiography. Analysis of left ventricular wall motion was performed in all patients using a 11-segment model of the left ventricular. The ejection fraction was determined by echocardiography in 47 patients and by radionuclide angiography in 50. The mean echocardiographic wall motion score of post-infarction angina patients (4.8 +/- 0.8) (+/- SEM) was lower than that of patients with left ventricular failure (9.5 +/- 0.5) (P less than 0.001), but was not different from patients suffering uncomplicated infarctions (4.6 +/- 0.3). The mean echocardiographic ejection fraction was also similar in post-infarction angina (45.3 +/- 4.0; n = 16) and patients with uncomplicated infarction (51.9 +/- 2.7; n = 17), but was lowest in the group of patients with left ventricular failure (35.1 +/- 3.3; n = 14). Similarly, the radionuclide ejection fraction of patients with post-infarction angina (41.4 +/- 3.4; n = 17) and patients with uncomplicated infarction (45.6 +/- 2.7; n = 19) did not differ, but was lower in patients with left ventricular failure (25.9 +/- 2.8; n = 14). The echocardiographic ejection fraction correlated with that obtained by radionuclide angiography in all 46 patients (r = 0.71, P less than 0.001). The wall motion score correlated with the radionuclide ejection fraction in all 50 patients (r = -0.73, P less than 0.001) and with the echocardiographic ejection fraction in 47 patients (r = -0.55, P less than 0.001). During follow-up, 3 (18%) patients suffering post-infarction angina and 2 (13%) with left ventricular failure died. New infarction was seen in 2 (12%) and 1 (7%) patients in these groups, respectively. We conclude that the left ventricular function of patients who suffer from post-infarction angina in the coronary care unit is good, but is impaired in those with even transient left ventricular failure. Echocardiographic assessment of cardiac function prior to hospital discharge was highly successful and may be performed in all such patients.