Skip to main content

Is follow-up echocardiogram mandatory after a STEMI?

Summary

Current guidelines do not advise follow-up echocardiograms after ST-segment elevation myocardial infarction (STEMI), unless the left ventricular ejection fraction is ≤40%. We present an interesting case of left ventricular pseudo-aneurysm–diagnosed 6 months after index STEMI presentation. Follow-up echocardiogram was performed in her case, due to jaw pain during routine haemodialysis. The patient was successfully treated with percutaneous closure device. This case raises the question of whether echo follow-up should be routinely advised after STEMI–even in those with minimal cardiac symptoms.

References

  1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal 2018 39 119–177. (https://doi.org/10.1093/eurheartj/ehx393)

    Article  Google Scholar 

  2. Becker RC, Hochman JS, Cannon CP, Spencer FA, Ball SP, Rizzo MJ, Antman EM. Fatal cardiac rupture among patients treated with thrombolytic agents and adjunctive thrombin antagonists: observations from the thrombolysis and thrombin inhibition in myocardial infarction 9 study. Journal of the American College of Cardiology 1999 33 479–487. (https://doi.org/10.1016/S0735-1097(98)00582-8)

    Article  Google Scholar 

  3. Pineda-De Paz DO, Hernández-del Rio JE, González-Padilla C, Esturau-Santaló RM, Romero-Palafox J, Grover-Paez F, Cardona-Muller D. Left ventricular free-wall rupture, a potentially lethal mechanical complication of acute myocardial infarction: an unusual and illustrative case report. BMC Cardiovascular Disorders 2019 19 80. (https://doi.org/10.1186/s12872-019-1063-x)

    Article  Google Scholar 

  4. Figueras J, Alcalde O, Barrabes JA, Serra V, Alguersuari J, Cortadellas J, Lidon RM. Changes in hospital mortality rates in 425 patients with acute ST-elevation myocardial infarction and cardiac rupture over a 30-year period. Circulation 2008 118 2783–2789. (https://doi.org/10.1161/CIRCULATIONAHA.108.776690)

    Article  Google Scholar 

  5. Moreno R, López-Sendón J, García E, Pérez de Isla L, López de Sá E, Ortega A, Moreno M, Rubio R, Soriano J, Abeytua M, et al. Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction. Journal of the American College of Cardiology 2002 39 598–603. (https://doi.org/10.1016/S0735-1097(01)01796-X)

    Article  Google Scholar 

  6. Pohjola-Sintonen S, Muller JE, Stone PH, Willich SN, Antman EM, Davis VG, Parker CB, Braunwald E. Ventricular septal and free wall rupture complicating acute myocardial infarction: experience in the multicenter investigation of limitation of infarct size. American Heart Journal 1989 117 809–818. (https://doi.org/10.1016/0002-8703(89)90617-0)

    Article  CAS  Google Scholar 

  7. Nakatani D, Sato H, Kinjo K, Mizuno H, Hishida E, Hirayama A, Mishima M, Ito H, Matsumura Y, Hori M, et al. Effect of successful late reperfusion by primary coronary angioplasty on mechanical complications of acute myocardial infarction. American Journal of Cardiology 2003 92 785–788. (https://doi.org/10.1016/s0002-9149(03)00883-x)

    Article  Google Scholar 

  8. Frances C, Romero A, Grady D. Left ventricular pseudoaneurysm. Journal of the American College of Cardiology 1998 32 557–561. (https://doi.org/10.1016/S0735-1097(98)00290-3)

    Article  CAS  Google Scholar 

  9. Meng X, Yang YK, Yang KQ, Zhang Y, Lu PP, Fan P, Ma LH, Zhou XL. Clinical characteristics and outcomes of left ventricular pseudoaneurysm: a retrospective study in a single-center of China. Medicine 2017 96 e6793. (https://doi.org/10.1097/MD.0000000000006793)

    Article  Google Scholar 

  10. McMullan MH, Maples MD, Kilgore TL Jr Hindman SH. Surgical experience with left ventricular free wall rupture. Annals of Thoracic Surgery 2001 71 1894–1898. discussion 1898-1899. (https://doi.org/10.1016/S0003-4975(01)02625-X)

    Article  CAS  Google Scholar 

  11. McIntyre CW. Effects of hemodialysis on cardiac function. Kidney International 2009 76 371–375. (https://doi.org/10.1038/ki.2009.207)

    Article  Google Scholar 

  12. Rodríguez-Padial L, Elola FJ, Fernández-Pérez C, Bernal JL, Bertomeu V, Iñiguez A. Patterns of inpatient care and readmission rates (30-day, 3-month and 1-year) in myocardial infarction in Spain. Differences between STEMI and NSTEMI. Revista Espanola de Cardiologia 2018 71 757–758. (https://doi.org/10.1016/j.rec.2017.05.008)

    Article  Google Scholar 

Download references

Funding

This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Janaki Srinivasan BSE.

Rights and permissions

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.(http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parasuraman, S.K., Srinivasan, J. & Broadhurst, P. Is follow-up echocardiogram mandatory after a STEMI?. Echo Res Pract 7, K27–K30 (2020). https://doi.org/10.1530/ERP-20-0022

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-20-0022

Key Words