The possibilities of echocardiography in the examination of patients with a high risk of sudden cardiac death after myocardial infarction

Introduction: T he left ventricular ejection fraction (EF) of less than 35% as the main prognostic marker, does not, always allow, to identify patients with an increased risk of ventricular tachyarrhythmias (VT) and sudden cardiac death. The complex echocardio-graphy examination of quantitative indices of systolic and diastolic LV function, using modern tissue doppler assessment, significantly expands the possibilities of this prediction.

Methods: The study included 90 patients with a con-firmed diagnosis of myocardial infarction (MI), among which in the post-infarction period (more than 40 days after MI), VT or ventricular fibrillation were recorded. The echocardiography transthoracic study was carried out according to a standardized protocol, with an addi-tional definition of the MAPSE, TAPSE, tissue indices S’ septal, S’ lateral, E / e’ and the recently recommended index E / e’ x S. The volume of left atrium (LA) was de-termined planimetrically in the mode of 4 and 2 cham-bers andc in relation to the area of the body.

Results: The patients included in the study were divided into two groups: I – with EF ≤35% (41 patients) and – with EF >35% (49 patients). Comparative analysis showed that patients with VF ≤35%, especially in the group of deceased patients, were more likely to have dilatation of LA >32 ml/m2, final LV systolic diameter >40 mm, LV diastolic diameter >58 mm, LA volume >64 ml. Evaluation of diastolic function in patients with EF ≤35% revealed the prevalence of dysfunction by re-strictive type (68.4%), with an E/e’ index >15 (55.5%), E/A >2 (60%) and decrease of time relaxation LV <60 msec (60%), reduction of MAPSE <8 mm, TAPSE<15 mm, increase of tissue index E/e ‘x S’ >2.83 (80%).

Conclusions: This study confirmed the relationship of mortality after myocardial infarction with systolic LV dysfunction, with EF ≤35% and early expansion of the LV cavity, increase in indexed LA volume, decrease in MAPSE, TAPSE indices, restrictive type of LV diastolic dysfunction, severe mitral valve insufficiency and in-crease of tissue index E / e ‘x S’ >2.83.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)