Prediction of single and multivessel coronary disease in patients after myocardial infarction according to quantitative ultrasound wall-motion analysis

Abstract

Regional changes in left ventricular size and function characterize left ventricular remodeling and start very early after myocardial infarction. We studied the diagnostic value of left ventricular dyssynergic patterns in predicting the presence of single versus multivessel disease (MVD). Fifty-three consecutive patients with acute myocardial infarction were studied by ECG, two-dimensional echocardiography, and angiography during the same hospitalization. Thirty-eight normal subjects served as the control group. According to the angiographic findings, the patients were categorized as having: single-vessel disease (SVD, n = 17), two-vessel disease ( n = 17), and three-vessel disease ( n = 19). Two-dimensional echocardiography was performed and optimal frames from five cardiac cycles were digitized and quantitatively analyzed off-line with a microcomputer. Echocardiographic wall-motion analysis demonstrated a depressed regional segmental thickening in the infarcted area that was characteristic for each echocardiographic view. In the segments remote from the infarcted area, however, the three patient groups displayed differences in function that ranged from hyperkinetic in patients with SVD to hypokinetic in patients with MVD. Patients with SVD constantly displayed a wider range of segmental thickening when compared with patients with MVD and the control group ( p < 0.05). In conclusion, patients with SVD after myocardial infarction display compensatory hyperkinesis of remote segments, which is attenuated in patients with MVD. The present study introduces new parameters of segmental myocardial function that might be helpful in predicting SVD and MVD in patients after myocardial infarction.