Prognostic implications of regional hyperkinesia and remote asynergy of noninfarcted myocardium.
To determine the clinical significance of regional hyperkinesia and remote asynergy of noninfarcted areas in patients with a first acute myocardial infarction (AMI), 2-dimensional echocardiography was performed in 113 consecutive patients within 12 hours after admission to the coronary care unit. In 98 patients (87%) all segments of the left ventricular wall were recorded. Infarct-associated asynergy was anterior in 63 and inferior in 35 patients. Regional hyperkinesia was present in 66 patients (67%)--44 of 63 with anterior (69%) and 22 of 35 with inferior (63%) infarcts--and was more frequently seen in patients with 1- and 2-vessel coronary artery disease (CAD) than in patients with 3-vessel CAD (87 and 72% vs 25%, p less than 0.001). In contrast to enzymatic infarct size, absence of regional hyperkinesia was significantly associated with a higher left ventricular wall motion score (p less than 0.01). Twenty patients died within 30 days after onset of AMI; in 15 (75%) regional hyperkinesia was absent. Absence of regional hyperkinesia, especially in anterior infarcts, was associated with a high mortality rate (13 of 19 patients [68%]). Remote asynergy, i.e., not adjacent to the infarct area and supposed to be related to another vascular region, was present in 17 of 98 patients (17%)--11 of 63 with anterior (17%) and 6 of 35 with inferior (17%) infarcts. Remote asynergy was present only in patients with multivessel CAD and was significantly related to a higher wall motion score (p less than 0.001), but not to enzymatic infarct size.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D004796:Clinical Enzyme Tests; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D003402:Creatine Kinase / Q000097:blood; D004452:Echocardiography; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D009206:Myocardium / Q000473:pathology
D007527:Isoenzymes; D003402:Creatine Kinase