Based on Killip class and left ventricular wall motion on echocardiography following acute myocardial infarction, a patient's one year mortality rate can be assessed. The Killip class roughly categorizes the clinical severity of the acute infarction. The ventricular wall motion serves as a measure of left ventricular function.
Killip class
|
Clinical Findings |
Clinical Group |
Killip Class |
|
no clinical signs of cardiac decompensation |
no heart failure |
I |
|
heart failure, with rales, S3 gallop and venous hypertension |
heart failure |
II |
|
frank pulmonary edema |
severe heart failure |
III |
|
hypotension (systolic blood pressure <= 90 mm Hg), cyanosis, oliguria, diaphoresis, pulmonary edema |
cardiogenic shock |
IV |
Echocardiographic Wall Motion
Measurement of Echocardiographic Wall Motion:
(1) performed on day 5 after acute myocardial infarction
(2) examined by 2-dimensional echocardiography through all available acoustic windows, using a 9 segment model (apex, anterior midventricular, anterior basal, lateral midventricular, lateral basal, posterior midventricular, posterior basal, medial midventricular, medial basal)
(3) myocardial motion in each segment is scored, provided the segment could be seen in at least one projection
|
Segmental Motion |
Score |
|
hyperkinesis |
3 |
|
normokinesis |
2 |
|
hypokinesis |
1 |
|
akinesis |
0 |
|
paradoxical motion |
-1 |
wall motion index =
= (sum of scores for all segments seen in at least one projection) / (number of segments seen in at least one projection)
Interpretation
The low risk group for 1 year mortality consisted of those with wall motion index > 1.3, and/or Killip class I.
|
Wall Motion Index |
Risk Group |
1 year mortality rate |
|
> 1.3 |
low |
2% |
|
> 1.0, <= 1.3 |
medium |
34% |
|
<= 1.0 |
high |
37% |
|
Killip Class |
1 year mortality rate |
|
I |
6% |
|
II |
26% |
|
III and IV |
48% |
Specialty: Cardiology
ICD-10: ,
