Short and long term predictive value of admission wall motion score in acute myocardial infarction. A cross sectional echocardiographic study of 345 patients.
A score of left ventricular segmental wall motion was used as a convenient rapid way to assess overall left ventricular function in acute myocardial infarction. Its success in risk stratification at admission was assessed by a blind review of cross sectional echocardiographic tape recordings from multiple acoustic windows. Sixty nine (20%) of the 345 patients died during hospital stay or within a one year follow up. The mean (SD) wall motion score in those who died was significantly higher than in those who survived (16.2 (5.9) vs 5.7 (3.9)). There were no differences between the group that died in hospital within three months of discharge and the group that died between three months and one year after discharge. Among the 31 patients who died in hospital, however, wall motion score was highest in 15 patients dying of cardiogenic shock (19.2 (4.2)). In 16 patients with lethal ruptures it was 13.5 (6.1). The nine patients with free wall ruptures had higher wall motion scores than those with ventricular septal rupture or papillary muscle rupture (15.7 (6.9) vs 8.5 (5.3)). Eight (3.3%) of 245 patients with a score less than 10 died, compared with 61 (61%) of 100 scoring greater than or equal to 10. The sensitivity of a score of greater than or equal to 10 in predicting death within one year was 88%, the specificity was 86%, the positive predictive value was 61%, and the negative predictive value was 97%.