title: Asynergy of the noninfarcted left ventricular inferior wall in anterior wall acute myocardial infarction secondary to isolated occlusion of the left anterior descending artery.
abstract: There are patients in whom left ventricular (LV) wall motion decreases in the noninfarcted region and LV systolic function declines globally despite the presence of a localized myocardial infarct attributable to narrowing or occlusion of a single coronary artery. This study examines angiographic characteristics of patients with chronic hypokinesia of noninfarcted myocardium after anterior wall acute myocardial infarction (AMI) due to narrowing of a single coronary artery, namely, the left anterior descending (LAD) artery. The LV ejection fraction, abnormalities in the motion of the noninfarcted LV inferior wall (SD/chord value by Sheehan's technique), the angiographic characteristics of the infarct-related coronary artery, the effect of acute reperfusion therapy, and presence of coronary risk factors were examined in 85 consecutive patients. The SD/chord value in the noninfarcted region showed a positive correlation with the LV ejection fraction (r = 0.505, p <0.0001). By multivariate analysis, hypertension (odds ratio = 0.53, 95% confidence interval [CI] 0.36 to 0.80), an infarct-related narrowing proximal to the origin of the first diagonal branch (odds ratio = 0.56, 95% CI 0.38 to 0.84), and patency of the infarct-related lesion during AMI (odds ratio = 1.56, 95% CI 1.03 to 2.30) were independent predictors of wall motion in the noninfarct region. In some patients with single-vessel anterior wall AMI, the motion of the noninfarcted inferior LV wall decreases during the chronic stage and cardiac function declines severely. In most of these patients, the infarct-related narrowing or occlusion is proximal to the origin of the first diagonal branch of the LAD artery.
authors.affiliation: Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Mitaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yoshino
authors.forename: M
authors.initials: M
authors.lastname: Taniuchi
authors.forename: E
authors.initials: E
authors.lastname: Kachi
authors.forename: H
authors.initials: H
authors.lastname: Shimizu
authors.forename: T
authors.initials: T
authors.lastname: Kajiwara
authors.forename: M
authors.initials: M
authors.lastname: Ohguchi
authors.forename: M
authors.initials: M
authors.lastname: Okada
authors.forename: K
authors.initials: K
authors.lastname: Ishikawa
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D002932:Cineangiography; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*