Observations of the relationship between left ventricular aneurysm and ST segment elevation in patients with a first acute anterior Q wave myocardial infarction

Abstract

Seventy-eight consecutive survivors of a first acute anterior Q wave myocardial infarction (AMI) underwent two-dimensional echocardiography (2D echo), colour Doppler echo and radionuclide angiography (RNA) for the diagnosis of left ventricular (LV) anteroapical aneurysm, in order to study the relationship of this complication to precordial ST segment elevation in these patients. The ST elevation (mm) in lead V2, the maximum ST elevation in V1-V6 and the sum of ST elevation in V1 to V6 were calculated. LV aneurysm was present in 19 patients by 2D echo, of whom 12 had a paradoxical systolic flow pattern (red and outward towards the transducer) at the apex. There was no difference between the mean ST elevation in V2 or the maximum ST elevation in V1-V6 in patients with and without an aneurysm, although the sum of ST elevations in V1 to V6 was higher in the former group (P < 0.01). ST elevation of patients with and without paradoxical systolic flow also did not differ significantly. Wall motion abnormality (akinesis and dyskinesis) by 2D echo in the anterior wall was seen in 74% of patients with and 36% of patients without an aneurysm (P < 0.005), and in the septal region in 63% and 47% of respective patients (P-NS). There was no difference between the magnitude of ST elevation in subgroups of patients with ejection fraction (EF) < or = 30% to > or = 40%, but the mean EF of patients with (23 +/- 2.1%) and without a LV aneurysm (34 +/- 1.3%) differed (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)