1 ECHOCARDIOGRAPHIC FINDINGS OF REGIONAL LEFT VENTRICULAR WALL MOTION ABNORMALITIES IN ACUTE CORONARY SYNDROME AND NORMAL ANGIOGRAM

Abstract

Purpose: Patients with acute coronary syndromes (ACS) should undergo early invasive diagnostic and treatment strategy according to the individual risk stratification. However, in a few cases angiography presents a normal angiogram. Echocardiography in ACS may help to assess the patients' risk and to disclose differential diagnosis in unclear cases. Few data are available on the analysis of echocardiographic findings in a patient population with ACS but normal angiogram. Methods: A total of 51 unselected patients (72.5% male, 53.3 ± 14.5 years) were included between 1999 and 2002. All patients underwent an emergency coronary angiography due to suspected ACS but showed a normal angiogram. Patients underwent echocardiographic examination prior to invasive procedure. Results: The preangiographic risk stratification was as follows: unstable angina (76.5%), elevated troponin T (30%), elevated creatine kinase (24%), electrocardiographic signs of ischemia (60.8%). Thirty‐one patients (60.6%) presented with a normal wall motion. The following regional wall motion abnormalities were seen: septal (n = 4, 7.8%), inferior (n = 9, 17.6%) and anterior (n = 7, 13.7%). A normal ejection fraction was detected in 40 patients (78.4%), a discrete reduction in 8 patients (15.7%), and a relevant reduction in three cases (5.9%). The invasive measurements of the ejection fraction (67 ± 14%) were without any difference to the echocardiographic measurement (68 ± 14%). Conclusions: In spite of a normal angiogram during ACS echocardiography shows regional left ventricular wall motion abnormalities in a relevant number of patients. These findings may influence the need of further diagnostic procedures and perhaps of pharmacological treatment in those patients. Echocardiography should be added to routine diagnostic procedures in patients with ACS.