Advantages of immediate two-dimensional echocardiography in patients with acute cardiac ischemic events

We hypothesized that the assessment of kinetic alterations on two dimensional echocardiogram (2DE) would provide greater diagnostic information than clinical symptoms and ECG changes only. The study was aimed to determine sensitivity of 2DE in patients with cardiac ischemic events and to improve the indications to thrombolysis. Three-hundred ninety-one patients (87 F; 304 M) hospitalized for suspected acute myocardial infarction (AMI), first episode, within 4 h from the onset of symptoms, suitable for thrombolysis Killip class I–II and with unstable angina (UA), were admitted in the study. Patients had to show ECG changes and alterations of segmentary motion on 2DE performed at entry, or 2DE alterations without ECG changes. The 2DE variables analyzed included right ventricular function and left ventricular systolic function. Thrombolysis was performed when 2DE and ECG changes were evidenced at the same time and when 2DE alterations without ECG changes were observed. Patients with UA treated with heparin alone were also studied. The presence of segmentary motion alterations was mandatory. Results: Inferior AMIs, 87 patients (60 ± 13 years), anterior AMI, 169 patients (61 ± 11 years); UA group subjected to thrombolysis, 87 patients (62 ± 12 years); UA group treated with heparin, 48 patients (62 ± 12 years). We noted only one patient false negative, and five patients false positive. Alterations of right ventricular function were observed in 24, 14 and nine patients with inferior, anterior AMI and UA, respectively. Normal ECG at entry was observed in seven, two and seven patients with inferior, anterior AMI and UA, respectively. ST-segment depression was observed in nine and 19 patients with inferior and anterior AMI respectively. Sensitivity, specificity and test accuracy were 99%, 96% and 98%, respectively. 2DE allows us to avoid the possibly harmful adjuvant therapies during the acute phases of cardiac ischemic events.