Prognostic value of electrocardiographic exercise testing and noninvasive assessment of left ventricular ejection fraction soon after acute myocardial infarction

Mark R. Starling, Michael H. Crawford, Rodney L. Henry, Nicholas J. Lembo, Gemma T. Kennedy, Robert A. O'Rourke

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

To determine the relative value of clinical findings, results of low-level treadmill electrocardiographic (ECG) exercise testing and left ventricular (LV) ejection fraction (EF) for predicting cardiac events in the year after an acute myocardial infarction (AMI), 72 patients who had had an uncomplicated AMI were studied with either radionuclide angiography or 2-dimensional echocardiography to assess LVEF and a low-level treadmill exercise test before hospital discharge. All patients were followed for 1 year. Nineteen patients (26%) had at least 1 cardiac event: coronary artery bypass grafting (11 patients), recurrent AMI (6 patients) or cardiac death (6 patients). Multiple logistic regression analysis revealed that total cardiac events were predicted by exercise ECG ST-segment depression or angina, prior AMI, ventricular ectopic activity during exercise and digoxin therapy (cumulative r = 0.58, p < 0.001). Coronary artery bypass grafting was predicted by exercise ECG ST-segment depression or angina (r = 0.29, p = 0.01). Recurrent AMI was predicted by exercise ECG ST-segment depression or angina, prior AMI and ventricular ectopic activity during exercise (cumulative r = 0.49, p < 0.001). Cardiac death was predicted by an LVEF of 40% or less (r = 0.38, p = 0.01). The presence of both an LVEF of 40% or less and ECG ST-segment depression on treadmill exercise testing defined a subgroup of patients with a high incidence of early cardiac death (33%). Thus, in addition to clinical evaluation, a noninvasive determination of LVEF and a low-level treadmill ECG exercise test performed before hospital discharge provide additive information for predicting 1-year morbidity and mortality in patients after an uncomplicated AMI.

Original languageEnglish (US)
Pages (from-to)532-537
Number of pages6
JournalThe American journal of cardiology
Volume57
Issue number8
DOIs
StatePublished - May 3 1986

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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