The prognostic value of a 2-dimensional echocardiogram (2-D echo) was determined in 46 patients (32 men and 14 women) who survived an acute myocardial infarction (MI) from November 1979 to December 1980. The mean age of the patients was 61 years (range 36 to 92). The MI was anterior in 21, inferior in 22 and indeterminate in 3; it was transmural in 31 and nontransmural in 15. A 2-D echo was obtained 10 to 15 days after the MI--that is, 1 to 3 days before hospital discharge. A wall motion score index (WMSI) was derived with the use of a 14-segment model of the left ventricle. Each segment was assigned a number corresponding to its wall motion (0 = hyperkinetic, 1 = normal, 2 = hypokinetic, 3 = akinetic, 4 = dyskinetic and 5 = aneurysm) and the WMSI was calculated by dividing the sum of these numbers by the number of segments visualized (1.0 = normal wall motion). During a mean follow-up of 21 months (range 15 to 28), 17 patients had a complication: death, recurrence of MI, congestive heart failure of New York Heart Association class III or IV, or angina graded New York Heart Association class III or IV. Patients with compared to those without complications had a significantly higher WMSI (2.2 +/- 0.4 and 1.7 +/- 0.5, p less than 0.005). The difference in WMSI between those who died and those who survived was not significant because of the small number of deaths.(ABSTRACT TRUNCATED AT 250 WORDS)