Early two-dimensional echocardiography in acute myocardial infarction. A study of left ventricular wall motion abnormalities.

Two-dimensional echocardiography (2DE) was utilized in 49 patients with a first transmural myocardial infarction, within 6 hours (+/- 3SD) after admission and again at 48 hours, in order to correlate initial left ventricular wall motion (LVWM) abnormalities with subsequent in-hospital cardiac complications. Analysis of systolic endocardial motion was made in 15 left ventricular segments in each patient and a total wall motion (WM) score was derived as a measure of the extent of myocardial involvement. LVWM abnormalities in relation to Killip class, peak total serum creatine kinase (CK) and serum glutamic oxaloacetic transaminase (SGOT) enzyme levels were also studied. Adequate echocardiograms for LVWM analysis were obtained in 43 patients. Thirteen patients had no infarct-related complications (group I) and 30 had complications (group II). The mean initial WM score in group I patients was 5.7 +/- 2.6 which was significantly lower than the 13.5 +/- 3.9 in group II (p less than 0.0001). A WM score of greater than 10 correlated with the occurrence of complications in 93% of patients. The WM score was significantly higher in admission Killip class 1 and 2 patients in group II compared with group I patients in class 1. However, no difference was noticed between the mean WM score of patients assigned to these 2 classes in group II. Peak CK and SGOT levels showed a poor correlation with the WM score in group I patients. In group II patients, only the peak SGOT levels correlated significantly with this score. We conclude that in patients with acute infarction, 2DE soon after admission can identify those likely to have in-hospital cardiac complications.