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European Heart Journal 1997 18(Supplement D):78-85; doi:10.1093/eurheartj/18.suppl_D.78
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Role of stress echocardiography in risk stratification early after an acute myocardial infarction

E. Picano, F. Lattanzi, R. Sicari, O. Silvestri, S. Polimeno, A. Pingitore, N. Petix, F. Margaria, O. Magaia, W. Mathias, Jr, J. Lowenstein, G. Minardi, C. Coletta, A. Borges on behalf of the EPIC (Echo Persantin International Cooperative) and EDIC (Echo Dobutamine International Cooperative) study groups

CNR, Institute of Clinical Physiology Pisa, Italy

Correspondence: Eugenio Picano, MD, PhD, FESC, CNR, Institute of Clinical Physiology, Via Paolo Savi, 8, 56123 Pisa, Italy

Resting and stress echocardiography is a ‘one-stop shop’, which enables a wide range of information to be collected on resting function, myocardial viability, and induced ischaemia, all of which are useful for prognostic stratification. Large scale, multicentre, prospectively collected data show the prognostic failure of resting function and inducible ischaemia, both independently and combined, which are especially effective in predicting cardiac death. The GISSI data show that the increment of risk as a result of reduction in ventricular function has a hyperbolic trend, with a relatively moderate increase in mortality for ejection fraction values between 50 and 30%, but with marked increases below 30%.

The EPIC data show that the 1-year risk of cardiac death is as low as 2% in patients with negative dipyridamole stress echocardiography; it doubles if the test is positive at a high dose, and is almost four times higher if it is positive at a low dose. In the field of prognostic stratification, in the absence of carefully controlled studies, the choice between coronary angiography as the only essential study, or use of a non-invasive test to discriminate access to catheterization currently reflect alternate philosophical approaches rather than scientifically based decisions. In the invasive approach, stress echocardiography offers relief from the vicious circle of chest pain—coronary angiography—revascularization. In the non-invasive and physiological approach, stress echo is capable of offering, in one sitting, an insight into the main determinants of survival: function, viability, and ischaemia.

Key Words: Echocardiography • function • ischaemia • viability


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