Value of transthoracic two-dimensional echocardiography in predicting viability in patients with healed Q-wave anterior wall myocardial infarction

• Published in: The American journal of cardiology 1995-11, Vol.76 (14), p.1002-1006
• Main Authors: Faletra, Francesco, Crivellaro, Wilma, Pirelli, Salvatore, Parodi, Oberdan, De Chiara, Francesca, Cipriani, Manlio, Corno, Roberto, Pezzano, Antonio
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Chi-Square Distribution; Coronary heart disease; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Heart; Heart - physiopathology; Humans; Male; Medical imaging; Medical research; Medical sciences; Middle Aged; Myocardial Contraction; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - pathology; Myocardial Infarction - physiopathology; Myocardium - pathology; Predictive Value of Tests; Tissue Survival
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(99)80284-7

The role of transthoracic echocardiography as a predictor of recovery after revascularization has not yet been established. Two-dimensional echocardiography was performed in 15 patients with a healed anterior wall myocardial infarction and severe, isolated stenosis of the left anterior descending coronary artery before, and 3 to 6 months after angiographically confirmed successful revascularization. The asynergic segments were classified into 2 groups according to 2 different echocardiographic patterns: those showing a normal acoustic reflectance with normal end-diastolic thickness (pattern A segments) and those showing an increase in acoustic reflectance and reduced end-diastolic thickness (pattern B segments). We hypothesized that pattern A segments were more likely to recover (viable myocardium) and that pattern B segments were consistent with irreversibility. A total of 240 segments in the 15 patients were evaluated before and after revascularization. Sixty-seven segments were asynergic; of these, 52 were judged to have pattern A and 15 pattern B. Of the 52 pattern A segments, 27 were hypokineric and 25 akinetic. All of the pattern B segments were akinetic (n = 9) or dyskinetic (n = 6). Pattern A was predictive of postoperative recovery in 39 of 52 segments (75%) (p < 0.0001); pattern B was predictive of irreversibly damaged tissue in 13 of 15 segments (87%) (p < 0.0001). Thus, in patients with healed anterior wall myocardial infarction, resting transthoracic echocardiography is a simple and reliable predictor of the behavior of asynergic segments after revascularization.