Utility of Stress Echocardiography for Postinfarct Prognosis

Although high-risk patients following myocardial infarct are usually identified in the acute stage by clinical assessment and determination of left ventricular function at rest, a significant percentage of infarct patients with increased risks, i.e., presence of residual myocardial ischemia, remain undetected at discharge. Since the yield of adequate images for interpretation stress echocardiograms has been significantly improved with digital technology, stress echocardiography has become a truly practical technique to identify these patients. Presence of remote asynergy, i.e., asynergy not directly adjacent to the infarcted area and supposed to be related to another vascular region, directly following cessation of dynamic exercise appears to be highly related to multivessel disease and an unfavorable follow-up period. Treadmill electrocardiographic findings, however, appeared to be of limited value in this respect. Furthermore, the echocardiographic ejection fraction was also a poor predictor. The versatility of the technique, lack of injections, or radiation hazard, and the relatively low cost will undoubtedly increase the application of stress echocardiography for postinfarct stratification.