Echocardiographic detection of infarct-localized asynergy and remote asynergy during acute myocardial infarction: correlation with the extent of angiographic coronary disease.

Publisher Website
Google Scholar
Abstract
To determine whether during acute myocardial infarction (MI), ischemia and asynergy can develop in areas remote from the infarct zone, a 2-part study was undertaken. In part 1, 51 patients with recent infarction (15.6 .+-. 4.1 days after MI) and 1-vessel disease of .gtoreq. 70% stenosis by angiography underwent 2-dimensional echocardiography (2-D-echo). On an 11-segment ventricular model, the 2-D echocardiograms were read blind and then compared with angiography to establish the distribution of regional asynergy for MI involving each of the 3 major coronary arteries. In part 2, 30 patients underwent 2-D echo 10.8 .+-. 3.1 h after onset of symptoms of acute MI. All 30 patients underwent coronary angiography before discharge and 19 had repeat 2-D echo 4-13 days after MI. One-vessel asynergy was defined as abnormal motion was present in 2 or more vascular regions. Of 30 patients with acute MI, 8 had 1-vessel disease (1VD) and 22 had multivessel disease (MVD) by angiography. Remote asynergy by 2-D echo was found in 17 patients with MVD (77%), but in none with IVD (P < 0.01). Of the 5 MVD patients without remote asynergy, 4 had only a 70% stenosis of a 2nd coronary vessel. Compensatory hyperkinesis was seen in 4 of the 1VD patients (50%), but in only 1 of the MVD patients (4.5%) (P = 0.005). Follow-up 2-D echo in 19 patients revealed improvement in the extent of asynergy in 2 of 5 IVD patients (33%) and in 10 of 13 MVD patients (77%) (P = 0.06). MI in the distribution of a single coronary vessel produces a distinctive, recognizable pattern of asynergy. The stress of infarction may induce compensatory hyperkinesis in 1VD patients, whereas in MVD patients this stress may exceed the perfusion capacity of the additionally stenosed vessels and result in remote asynergy. The extent of early asynergy during acute myocardial infarction overestimates the extent of asynergy present after recovery from the infarct.

This publication has 49 references indexed in Scilit: