ST elevation myocardial infarction echocardiography

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Overview

Echocardiography can be quite useful in identifying complications of ST elevation MI. If the diagnosis of ST elevation MI is clear, reperfusion should not be delayed pending the performance of an echocardiogram.

Role of Echocardiography in Diagnosing MI

  • Echocardiography is not a routine test for the diagnosis of myocardial infarction (MI) since the diagnosis relies mainly on the ECG findings and elevation in cardiac enzymes. However, it is appropriate to do an echocardiography when a patient presents with acute chest pain suspicious of MI and the ECG is not diagnostic. In addition, echocardiography can also be used for the diagnosis of MI when the results of the ECG and cardiac enzymes are suggestive of MI in the absence of chest pain.[1]
  • Regional wall motion abnormality (RWMA) is an echocardiographic sign suggestive of ischemia. However, despite its high sensitivity, RWMA is not highly specific for MI.[2]

Role of Echocardiography in Detecting Post MI Complications

Echocardiography is an appropriate test for the complications of MI, including:[1]

Role of Echocardiography in Risk Assessment After STEMI

According to the 2013 ACCF/AHA guideline for the management of STEMI, left ventricular ejection fraction should be assessed in all patients following MI (Class I, level of evidence C).[3]

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary[3]

Class IIb
"1. Noninvasive testing for ischemia might be considered before discharge to evaluate the functional significance of a noninfarct artery stenosis previously identified at angiography. (Level of Evidence: C)"

2012 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-segment Elevation[4]

Class I
"1. In the acute phase, when diagnosis is uncertain, emergency echocardiography may be useful. However, if inconclusive or unavailable and persistent doubt, emergency angiography should be considered. (Level of Evidence: C)"
"2. All patients should have an echocardiography for assessment of infarct size and resting LV function. (Level of Evidence: B)"
"3. For patients with multivessel disease, or in whom revascularization of other vessels is considered, stress testing or imaging (e.g. using stress myocardial perfusion scintigraphy, stress echocardiography, positron emission tomography or MRI) for ischemia and viability is indicated. (Level of Evidence: A)"

References

  1. 1.0 1.1 American College of Cardiology Foundation Appropriate Use Criteria Task Force. American Society of Echocardiography. American Heart Association. American Society of Nuclear Cardiology. Heart Failure Society of America. Heart Rhythm Society; et al. (2011). "ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Use Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians.". J Am Soc Echocardiogr. 24 (3): 229–67. PMID 21338862. doi:10.1016/j.echo.2010.12.008. 
  2. Sabia P, Afrookteh A, Touchstone DA, Keller MW, Esquivel L, Kaul S (1991). "Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography.". Circulation. 84 (3 Suppl): I85–92. PMID 1884510. 
  3. 3.0 3.1 O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA; et al. (2013). "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.". Circulation. 127 (4): 529–55. PMID 23247303. doi:10.1161/CIR.0b013e3182742c84. 
  4. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C; et al. (2012). "ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.". Eur Heart J. 33 (20): 2569–619. PMID 22922416. doi:10.1093/eurheartj/ehs215. 

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