[Old myocardial infarct: echocardiographic study]. / L'infarto miocardico di vecchia data: studio ecocardiografico.

UNLABELLED: A large number of patients survives many years after an acute myocardial infarction (AMI). Echocardiographic study in patients with a very old myocardial infarction (VOMI) can certainly contribute to a better understanding of anatomical and functional damage of the heart. AIM OF THE STUDY: To describe the echocardiographic pattern and to analyze differences between patients with anterior (ant.) and inferior (inf.) VOMI and subjects treated or not with a thrombolytic agent (T+ and T-). METHODS, DESIGN OBSERVATIONAL STUDY: We performed an M-B mode and color-doppler echocardiographic examination of 136 patients (M/F: 130/6), mean age 64.4 +/- 9 years, with an isolated VOMI that is least 5 years old (mean 9.5 +/- 3.1; range 5-16 years), with a good visualization of left ventricular (lv) endocardial profile and without left bundle branch block or valvulopathy is related to myocardial infarction. We established electrocardiographic site and thrombolytic treatment on a documental basis dating from AMI. End diastolic volume index (EDVi), end systolic volume index (ESVi), ejection fraction (EF), wall motion score index (WMSI), left atrial antero-posterior diameter (AD) and presence of any lv aneurysm, scar, thrombus, mitral regurgitation (MR) were assessed. Data were compared with those of 100 normal subjects (controls) with sex, age and physical settlement similar to those of the patients. RESULTS: EDVi appeared much more enlarged in patients than in controls (p < 0.0001). There was a large difference between ant. VOMI and inf. VOMI (p < 0.0001); where as a smaller increase was noticed in T+ versus (vs) T- patients (p = 0.04). In comparison with controls, a smaller difference was observed in inf. VOMI (p = 0.002). ESVi presented a similar behaviour in patients vs controls and ant. vs inf. VOMI (p < 0.0001), but there was no statistical difference between T+ and T- while a large difference was detected between inf. VOMI and controls (p < 0.0001). EF was lower in patients than in controls (p < 0.0001) and in ant. VOMI rather than in inf. VOMI (p < 0.0001); no statistically relevant difference was seen between T+ and T-, while a large difference was observed between inf. VOMI and controls (p < 0.0001). WMSI appeared to be significantly worse in patients vs controls (p < 0.0001), but there was also a great difference between ant. and inf. VOMI (p < 0.0001). T+ had a better index in comparison with T- (p = 0.02). There was also large difference between inf. VOMI and controls (p < 0.0001). AD was larger in patients than in controls (p < 0.0001), but there was no statistical difference between ant. and inf. VOMI and T+ and T-; in comparison with controls, smaller difference was seen in inf. VOMI (p = 0.04). Aneurysm was seen in 16% of patients, more prevalently in ant. (27%) than in inf. VOMI (5%) (p < or = 0.001). Scarring was seen in 45% of patients and, like aneurysms, more in ant. (69%) than in inf. VOMI (22%) (p < or = 0.001). Thrombus was rarely detected (5%) and only in ant. VOMI (12%) with aneurism (p < or = 0.01 vs inf.). MR was seen in a large number of patients (48%) and in 27% of controls (p < or = 0.001). No significant difference was pointed out between ant. and inf. VOMI. Aneurysm, thrombus and MR (21.8 and 55% respectively) were more prevalent in T- than in T+ (9.3 and 48% respectively), with no statistical significance. Scarring prevailed in T+ (48%) rather than in T- (43%), without any statistical difference. CONCLUSIONS: Patients with VOMI show increased lv volumes, decreased EF and persistence of regional wall motion abnormalities. Volumetric and kinetic modifications mainly involve ant. VOMI, but inf. VOMI also presents similar but smaller modifications. Left atrial dimensions also increase in VOMI. Aneurysms, scars, MR occur frequently; while the presence of thrombus is infrequent. Thrombolytic therapy appears to be a long-term protection from anatomical and functional damage. Echocardiography seems to be the ideal tech

[The observation by echocardiographic monitoring of the behavior of the main morphofunctional parameters of the left ventricle after an acute myocardial infarct]. / Osservazione mediante monitoraggio ecocardiografico del comportamento dei principali parametri morfofunzionali del ventricolo sinistro dopo infarto miocardico acuto.

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.