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Prediction of cardiac mortality after myocardial infarction: the role of maximal treadmill stress echocardiography.
Journal of the American Society of Echocardiography 2001 January
Patients frequently undergo low-level exercise treadmill testing after acute myocardial infarction (MI) and, in the absence of inducible ischemia, a maximal test several weeks later. This study examines 203 patients who had 2-dimensional echocardiography before and after a maximal Bruce protocol exercise treadmill test performed 4 to 6 weeks after MI. The subjects were followed for a mean of 43 months (range 1 to 77 months). Predictors of cardiac mortality by multivariate or univariate analysis included an ejection fraction < or =40%, diabetes, age > or=70 years, and ischemia by exercise echocardiography but not by electrocardiography. Therefore, standard electrocardiographic monitoring during exercise treadmill testing 6 weeks after MI fails to predict cardiac mortality. The addition of pre-exercise and post-exercise treadmill stress echocardiography to readily available clinical parameters identifies those patients at greatest risk for cardiac death (resting ejection fraction < or=40%) and detects residual exercise-induced ischemia that may be of additional prognostic value.
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