Author + information
- Received May 4, 1987
- Revision received August 14, 1987
- Accepted September 24, 1987
- Published online February 1, 1988.
- Jonathan L. Isaacsohn, MD∗,a,b,
- Mark G. Earle, BAa,b,
- Andrew J. Kemper, MD, FACCa,b and
- Alfred F. Parisi, MD, FACCa,b
- ↵∗Address for reprints: Jonathan L. Isaacsohn, MD, Cardiology Section, Veterans Administration Medical Center, 1400 VFW Parkway, West Roxbury, Massachusetts 02132.
Recent data suggest that patients who manifest extension of their acute myocardial infarct have a worse prognosis than do those who do not have this complication and, if identified early, may be candidates for more aggressive intervention. Serial two-dimensional echocardiography was used to diagnose myocardial infarct extension in 33 consecutive patients and its sensitivity was compared with that of electrocardiography (ECG) and serum creatine kinase determination. Infarct extension was diagnosed clinically using ECG and enzymatic criteria. The echocardiograms were scored using a weighted regional scoring system, with each segment of the left ventricle ascribed a percent of the total left ventricular mass. Abnormal regions were summed to yield a percent asynergy.
In the postinfarction period, 19 episodes of acute ischemia occurred; in 9 of these episodes clinical extension was confirmed, and in 7 of the 9 episodes echocardiographic extension was detected. In the patients in whom infarct extension was documented clinically, the mean asynergy score increased from a mean of 19.2 ± 11.3% to 36.1 ± 18.2% (p < 0.01). Where no extension was detected, the asynergy score improved from the initial 31.5 ± 24.1% to 28.3 ± 21.9% (p < 0.05). The extent of the change in echocardiographic wall motion abnormality was not predicted by the amount of creatine kinase reelevation.
Electrocardiography alone failed to distinguish which episodes of ischemia represented infarct extension and which did not. Greater degrees of asynergy were associated with worse in-hospital mortality. Two-dimensional echo cardiography is a useful method for detecting myocardial infarct extension providing a means of assessing functional impact and prognosis.
☆ This study was supported by the Medical Research Service of the U.S. Veterans Administration. It was presented in part at the 59th Annual Scientific Sessions of the American Heart Association, November 1986, Dallas, Texas.
- Received May 4, 1987.
- Revision received August 14, 1987.
- Accepted September 24, 1987.