Two-dimensional echocardiographic recognition of myocardial injury in man: comparison with postmortem studies.

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Abstract
To assess the accuracy of phased-array 2-dimensional echocardiography in detecting, localizing and quantifying myocardial injury in man, the relationship of 2-dimensional echocardiographic wall motion abnormalities to morphologic evidence of myocardial infarction was evaluated in 20 autopsied patients. Comparisons were made between independent 2-dimensional echocardiographic readings of left ventricular segmental wall motion and morphologic evidence of myocardial injury. Of 15 infarcts, 14 were detected by regional akinesis, dyskinesis or hypokinesis. The relationship between abnormal segmental wall motion and morphologic evidence of myocardial necrosis or fibrosis was significant. Of 88 infarcted segments, 79 (90%) showed abnormal wall motion; 38 of 82 (46%) morphologically normal segments demonstrated wall motion abnormalities. Of 65 segments that showed regional akinesis or dyskinesis, 58 were transmurally infarcted. Of 38 pathologically normal segments seen by 2-dimensional echocardiography as akinetic or dyskinetic, 25 were adjacent to scar. Hypokinesis was non-specific (31 segments nornal, 21 subendocardial infarction). Normal wall motion excluded transmural infarction (0 of 46 segments), but in 1 patient was associated with subendocardial injury (9/42 segments). The circumferential extent of regional akinesis or dyskinesis was assessed in blind fashion with a light-pen system, expressed as a percentage of end-diastolic circumference. This was compared with the corresponding cross section of the left ventricle examined pathologically. By linear regression, extent of 2-dimensional echocardiographic akinesis or dyskinesis and extent of left ventricular circumference demonstrating morphologic evidence of transmural infarction correlated well: pathologic percent circumference infarcted = 1.14 (2-dimensional echocardiographic percent circumference akinetic/dyskinetic) -14.48; r = 0.90. Wall motion abnormalities overestimated the amount of myocardial circumference infarcted, possibly because of the proximity of morphologically normal segments to scar or because segments adjacent to the lesions were reversibly ischemic. Two-dimensional echocardiographic evidence of regional wall motion abnormality apparently is sensitive in detecting and localizing segmental phatologic myocardial lesions, but overestimates their extent.