• echocardiography
• left ventricular ejection fraction
• acute myocardial infarction
• biplane Simpson’s method

• AMI, acute myocardial infarction
• CATS, captopril and thrombolysis study
• CONSENSUS, cooperative North Scandinavian enalapril survival study
• DEFIANT, doppler flow and echocardiography in functional cardiac insufficiency: assessment of nisoldipine therapy
• LEVEREM, left ventricular remodelling
• LVEF, left ventricular ejection fraction

In this issue of Heart, Nijland and colleagues address the important question on how low dose dobutamine echocardiography at an early stage can predict later improvement in left ventricular ejection fraction (LVEF) after an acute myocardial infarction (AMI).¹ A ≥ 5% increase in LVEF was arbitrarily chosen to represent an improvement, and they found this to occur in 21 (20%) of 107 patients with AMI. If dobutamine echocardiography revealed myocardial viability in ≥ 2 segments, the prediction of an increase in LVEF had a sensitivity of 81% and a specificity of 65%. Other predictors for such an improvement were non-Q wave infarction and anterior infarction, but myocardial viability assessed with the stress echo method was the single best predictor of improvement in LVEF.

This study raises some important principal questions related to the echocardiographic methodology in assessing left ventricular volumes and ejection fraction. If the true prognostic value of stress echo post-AMI is to be assessed, one must be convinced that those with an apparent increase in LVEF had a true improvement. This focuses on the degree of reproducibility of the echocardiographic measurements after three months. The authors report that their intra- and …