Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1975 Jan;37(1):46–59. doi: 10.1136/hrt.37.1.46

Echoventriculographic detection, localization, and quantification of left ventricular asynergy in acute myocardial infarction. A correlative echo- and electrocardiographic study.

Heikkil J, M Nieminen
PMCID: PMC484153  PMID: 1111559

Abstract

"Echoventriculography", an echocardiographic method specially developed to scan the regional function of the left ventricle, is introduced for studying left ventricular wall motion alteration in patients with acute myocardial infarction. Purposeful probe directions, a 2:1 magnification, and careful adjustment of the gain and reject levels allowed a direct echocardiographic scanning of practically the entire left ventricle. Technically acceptable echoventriculograms were obtained from the upper and lower halves of the septal, anterior, lateral, and postero-inferior left ventricle segments in all observations on 30 consecutive patients with acute myocardial infarction. Various degrees of regional left ventricular asynergy were present in 100 per cent of the patients with acute myocardial infarction. In contrast, synergic ventricular segmental wall motion was observed in 40 healthy subjects. Pronounced asynergy was already detectable within 12 hours from onset of the symptoms of acute myocardial infarction. Echoventriculography detected acute left ventricular asynergy as well in the anteroseptal or lateral as in the posteroinferior locations. The anterior and/or septal infarction (13 of the 30 patientsy always showed a paradoxical systolic motion of the, generally large, infarcted areas. The amplitude of abnormal outward motion was up to 5 mm. In the posteroinferior infarctions (17 patients) akinetic or hypokinetic modes prevailed. The contractile function of the uninvolved segments could be measured at the same time. Hypercontractile left ventricular wall motion was common in these healthy areas in acute myocardial infarction. These findings provide useful insight into the various components of the overall left ventricular pump function in acute myocardial infarction. The validity of the echoventriculographic evaluations of the segmental left ventricular function subsets was further confirmed in 2 patients undergoing left ventricular cineangiographic studies and in 2 by necropsy. The site of the asynergic left ventricular wall motion abnormalities correlated excellently with electrocardiographic prediction of the site of acute myocardial infarction. The echoventriculographic analysis proved to be more accurate in detecting asynergy than was the electrocardiogram. This new echoventriculographic method may become a useful tool for serial noninvasive alalysis of left ventricular performance, in detecting both the asynergic areas and the reserve function of the normal regions in acute myocardial infarction.

Full text

PDF
46

Images in this article

56Image
on p.56

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbott J. A., Scheinman M. M. Nondiagnostic electrocardiogram in patients with acute myocardial infarction. Clinical and anatomic correlations. Am J Med. 1973 Nov;55(5):608–613. doi: 10.1016/0002-9343(73)90182-4. [DOI] [PubMed] [Google Scholar]
  2. Baxley W. A., Jones W. B., Dodge H. T. Left ventricular anatomical and functional abnormalities in chronic postinfarction heart failure. Ann Intern Med. 1971 Apr;74(4):499–508. doi: 10.7326/0003-4819-74-4-499. [DOI] [PubMed] [Google Scholar]
  3. Baxley W. A., Reeves T. J. Abnormal regional myocardial performance in coronary artery disease. Prog Cardiovasc Dis. 1971 Mar;13(5):405–421. doi: 10.1016/0033-0620(71)90009-0. [DOI] [PubMed] [Google Scholar]
  4. Cox J. L., McLaughlin V. W., Flowers N. C., Horan L. G. The ischemic zone surrounding acute myocardial infarction. Its morphology as detected by dehydrogenase staining. Am Heart J. 1968 Nov;76(5):650–659. doi: 10.1016/0002-8703(68)90164-6. [DOI] [PubMed] [Google Scholar]
  5. Heikkilä J., Luomanmäki K., Pyörälä K. Serial observations on left ventricular dysfunction in acute myocardial infarction. I. Gallop sounds, ventricular asynergy and radiological signs. Acta Med Scand. 1971 Jul-Aug;190(1-2):89–104. doi: 10.1111/j.0954-6820.1971.tb07400.x. [DOI] [PubMed] [Google Scholar]
  6. Herman M. V., Gorlin R. Implications of left ventricular asynergy. Am J Cardiol. 1969 Apr;23(4):538–547. doi: 10.1016/0002-9149(69)90007-1. [DOI] [PubMed] [Google Scholar]
  7. Inoue K., Smulyan H., Mookherjee S., Eich R. H. Ultrasonic measurement of left ventricular wall motion in acute myocardial infarction. Circulation. 1971 Jun;43(6):778–785. doi: 10.1161/01.cir.43.6.778. [DOI] [PubMed] [Google Scholar]
  8. Jacobs J. J., Feigenbaum H., Corya B. C., Phillips J. F. Detection of left ventricular asynergy by echocardiography. Circulation. 1973 Aug;48(2):263–271. doi: 10.1161/01.cir.48.2.263. [DOI] [PubMed] [Google Scholar]
  9. James T. N. The coronary circulation and conduction system in acute myocardial infarction. Prog Cardiovasc Dis. 1968 Mar;10(5):410–449. doi: 10.1016/s0033-0620(68)80002-7. [DOI] [PubMed] [Google Scholar]
  10. Kitamura S., Kay J. H., Krohn B. G., Magidson O., Dunne E. F. Geometric and functional abnormalities of the left ventricle with a chronic localized noncontractile area. Am J Cardiol. 1973 Jun;31(6):701–707. doi: 10.1016/0002-9149(73)90003-9. [DOI] [PubMed] [Google Scholar]
  11. Klein M. D., Herman M. V., Gorlin R. A hemodynamic study of left ventricular aneurysm. Circulation. 1967 Apr;35(4):614–630. doi: 10.1161/01.cir.35.4.614. [DOI] [PubMed] [Google Scholar]
  12. Maroko P. R., Kjekshus J. K., Sobel B. E., Watanabe T., Covell J. W., Ross J., Jr, Braunwald E. Factors influencing infarct size following experimental coronary artery occlusions. Circulation. 1971 Jan;43(1):67–82. doi: 10.1161/01.cir.43.1.67. [DOI] [PubMed] [Google Scholar]
  13. Russell R. O., Jr, Hunt D., Rackley C. E. Left ventricular hemodynamics in anterior and inferior myocardial infarction. Am J Cardiol. 1973 Jul;32(1):8–16. doi: 10.1016/s0002-9149(73)80080-3. [DOI] [PubMed] [Google Scholar]
  14. Sniderman A. D., Marpole D., Fallen E. L. Regional contraction patterns in the normal and ischemic left ventricle in man. Am J Cardiol. 1973 Apr;31(4):484–489. doi: 10.1016/0002-9149(73)90299-3. [DOI] [PubMed] [Google Scholar]
  15. Swan H. J., Forrester J. S., Diamond G., Chatterjee K., Parmley W. W. Hemodynamic spectrum of myocardial infarction and cardiogenic shock. A conceptual model. Circulation. 1972 May;45(5):1097–1110. doi: 10.1161/01.cir.45.5.1097. [DOI] [PubMed] [Google Scholar]
  16. Vogel J. H., Cornish D., McFadden R. B. Underestimation of ejection fraction with singleplane angiography in coronary artery disease: role of biplane angiography. Chest. 1973 Aug;64(2):217–221. doi: 10.1378/chest.64.2.217. [DOI] [PubMed] [Google Scholar]
  17. Watanabe T., Covell J. W., Maroko P. R., Braunwald E., Ross J., Jr Effects of increased arterial pressure and positive inotropic agents on the severity of myocardial ischemia in the acutely depressed heart. Am J Cardiol. 1972 Sep;30(4):371–377. doi: 10.1016/0002-9149(72)90567-x. [DOI] [PubMed] [Google Scholar]
  18. Wharton C. F., Smithen C. S., Sowton E. Changes in left ventricular wall movement after acute myocardial infarction measured by reflected ultrasound. Br Med J. 1971 Oct 9;4(5779):75–77. doi: 10.1136/bmj.4.5779.75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Williams R. A., Cohn P. F., Vokonas P. S., Young E., Herman M. V., Gorlin R. Electrocardiographic, arteriographic and ventriculographic correlations in transmural myocardial infarction. Am J Cardiol. 1973 May;31(5):595–599. doi: 10.1016/0002-9149(73)90328-7. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES