Does two-dimensional echocardiography accurately detect and localize myocardial injury compared to postmortem morphologic evidence in autopsied patients?
Two-dimensional echocardiography is highly sensitive for detecting transmural myocardial infarction through regional wall motion abnormalities, though it is less specific for subendocardial injury.
To assess the accuracy of phased-array two-dimensional echocardiography in detecting, localizing and quantifying myocardial injury in man, the relationship of two-dimensional echocardiographic wall motion abnormalities to morphologic evidence of myocardial infarction was evaluated in 20 autopsied patients. Comparisons were made between independent two-dimensional echocardiographic readings of left ventricular segmental wall motion and morphologic evidence of myocardial injury. Of 15 infarcts, 14 were detected by regional akinesis, dyskinesis or hypokinesis. The relationship between abnormal segmental wall motion and morphologic evidence of myocardial necrosis or fibrosis was significant. Seventy-nine of 88 (90%) of infarcted segments showed abnormal wall motion, although 38 of 82 (46%) of morphologically normal segments also demonstrated wall motion abnormalities. Fifty-eight of 65 segments that showed regional akinesis or dyskinesis were transmurally infarcted. Twenty-five of 38 pathologically normal segments seen by two-dimensional echocardiography as akinetic or dyskinetic were adjacent to scar. Hypokinesis was non- specific (31 segments normal, 21 subendocardial infarction). Normal wall motion excluded transmural infarc- tion (0 of 46 segments), but in one patient was associated with subendocardial injury (nine/42 segments).
Weiss et al. (1981) studied this question.