[Prediction of coronary lesions by two-dimensional echocardiography in patients with healed myocardial infarction].
Regional left ventricular wall motion abnormalities were assessed by two-dimensional echocardiography (2-DE) in 66 patients with healed myocardial infarction (MI) and the results were compared with those of coronary angiography which was performed at nearly the same time as 2-DE. The left ventricular wall was divided into 14 segments and asynergy was assessed in each segment. To compare the severity of segmental asynergy with coronary artery lesions, relation between segments and coronary artery perfusion was assumed as follows: the anterior wall, anterior septum and apex corresponded to the anterior descending artery (LAD); the lateral and inferior walls corresponded to the left circumflex artery (LCX); and the posterior septum and inferior wall corresponded to the right coronary artery (RCA). One vessel disease: In all 24 patients with MI induced by LAD lesions, regional asynergy was identified in the anterior wall, anterior septum and apex. All patients had advanced asynergy (severe hypokinesis, akinesis or dyskinesis) except one with subendocardial infarction. Advanced asynergy was identified in the other segments including the lateral wall (one patient) and the posterior septum (11 patients), but such asynergy was not associated with that of the inferior wall. In four patients with MI induced by RCA lesions, regional asynergy appeared in localized segments of the posterior septum and inferior wall, and the asynergy was severe in all patients except one in whom collaterals were well-developed. In four patients with MI induced by LCX lesions, asynergy was observed in both the lateral and inferior walls. In only one patient, mild asynergy was identified in the apex. Multi-vessel disease: In both groups with double vessel (16 patients) and triple vessel (16 patients) disease, asynergy was recognized in the affected areas of the major coronary artery which was considered responsible for the infarction, irrespective of the severity of the coronary stenosis. Also, there was no significant correlation between the severity of coronary artery stenosis and segmental wall motion abnormalities in non-infarcted areas. No significant correlation was observed between the severity of regional wall motion abnormalities in the infarcted areas and the degree of development of collaterals. In patients with MI induced by LAD lesions, more extensive asynergy in the anterior wall and anterior septum at the basal portion was observed in the patient group with proximal stenosis than in the group with distal stenosis.(ABSTRACT TRUNCATED AT 400 WORDS)
D000328:Adult; D000368:Aged; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology*