Echo‐ and electrocardiographic findings in relation to autopsy in myocardial infarction

Abstract Summary: Left ventricular (LV) wall motion studied by echocardiography (Echo) may give additional information of site and extension of myocardial damage in myocardial infarction (MI) compared to conventional ECG. We have therefore investigated patients with apparent poor short‐term prognosis in the acute phase of an MI. Adequate autopsy data were available in 17 patients who died within a stipulated 2‐month period. The left ventricle was divided into 16 segments and concomitant evaluation with ECG and Echo was possible in 164 (56%) of 272 (16 × 17) segments. The Echo parameter mean systolic wall velocity (V) was used with its percent deviation (PD‐V) from that obtained in a healthy group. A reduction in PD‐V by 30% was used for separating healthy from infarcted segments. This limit gives the method a sensitivity (S) of 92%, specificity (SP) 66%, and predictive accuracy (PA) of 79% with highest PA for anterior and posteroseptal segments (78–87%) in contrast to inferior and lateral segments (73%). Sensitivity for single ECG leads is lower (76%) with SP and PA of 76 and 75%, respectively. PA was highest for an‐teroseptal and lateral segments (83%) as compared to 60% for inferoposterior segments. In 11 patients the MI was predominantly anterior which was adequately reflected by both Echo and ECG. Extension beyond this site was better evidenced by Echo than ECG. ECG was nondiagnostic in true posterior extension in contrast to Echo which was correct in all. In 6 patients the MI was predominantly inferior. Echo correctly identified this in 82% of segments and ECG in 71%. Again extensions beyond this site were better evidenced by Echo. Extensions to the true posterior and anterolateral walls were indicated in 79–100% by Echo, while ECG indicated MI in two posterior segments only. We conclude that Echo mapping provides useful information of segmental LV wall function in MI. In comparison to ECG additional information is obtained of MI involvement of especially the basal segments as well as the apical‐posteroseptal segments and also of extension beyond the conventional anterior and inferior locations.