Clinical impact of echocardiography in prognostic stratification after acute myocardial infarction

Risk stratification is mandatory in the management of the postinfarction period. The identification of high-risk patients, on the basis of clinical data (recurrent angina, overt heart failure, etc.), is quite easy, whereas stratification of uncomplicated subjects needs an accurate noninvasive strategy. In the last 20 years, echocardiography has been gaining an increasing role, allowing increasingly precise evaluation of infarct size. This detection of the extent of infarct size has a definite prognostic value. Since 1980, we have observed that a dysfunctioning left ventricular myocardium >40% marked patients with a poor prognosis. These observations are most important in asymptomatic infarct patients, in whom clinical features may not reflect the amount of left ventricular dysfunction. Our recent results on a large series of patients with acute myocardial infarction (MI) without overt heart failure have shown that the extension of wall motion abnormalities at 2-dimensional (2D) echocardiography was highly predictive of cardiac death or new coronary events in a 3-year follow-up (univariate analysis; p