[The observation by echocardiographic monitoring of the behavior of the main morphofunctional parameters of the left ventricle after an acute myocardial infarct].

In acute myocardial infarction (AMI) echocardiography is a means for revealing anatomical and functional damage. Up to date utilization of this method to monitor cardiac function during the in-hospital phase of AMI is rarely adopted. We performed serial echocardiographic examinations during the in-hospital phase of AMI to study the behaviour of left ventricular function at day 1, day 4-6 and at pre-discharge (after 11 +/- 3 days from admission). End diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF), wall motion score index (WMSI) were assessed. The study involved 108 patients with first AMI and with adequate echocardiographic resolution, selected from a population of 194 subjects consecutively admitted to the coronary care unit for suspected AMI. The population features were: mean age 60 +/- 13 years, 89 males and 19 females, 61 with anterior AMI and 47 with inferior AMI, 77 treated and 31 not treated by thrombolysis. Echocardiography was performed on day 1 (always after thrombolysis in treated patients), day 4-6, and at pre-discharge (11 +/- 3 days after admission) EDV, ESV and EF were calculated by single plane area-length method from the apical 4-chamber view; WMSI was calculated on a left ventricular 16-segment model, using the following scale: 1: normal or hyperkinetic; 2: hypokinetic; 3: akinetic, 4: dyskinetic, 5: aneurysm, and dividing the sum by the number of visualized segments. A modification in EDV and ESV was considered if there was a +/- 10% change in comparison with the initial or previous examination; EF was also considered to be modified for changes +/- 10%; WMSI was considered to be improved or worsened either in case of score variations of previously altered segments or in case of detection of new abnormally contracting segments. In order to improve reproducibility and adequate comparison of serial measurements we used a cine-loop technology with dual or quad-screen imaging. EDV, ESV EF and WMSI presented heterogeneous variations from day 1 to pre-discharge. For each observed parameter, we identified three main groups and six subgroups. Main groups identify stability (Group I), improvement (Group II) and worsening (Group III); subgroups, concerning only Group II and III and named a, b and c, identify the characteristics of improvement or worsening: a: continuous or persistent, b: late and c: discontinuous. No significant differences were found in each parameter between thrombolysed and non thrombolysed patients. As to the concomitance of belonging to the same main group, EF and WMSI presented the greatest agreement: 76% of patients; ESV, EF and WMSI agreed in 71% of patients; EDV, ESV, EF and WMSI agreed only in 59% of patients.