Detection of Left Ventricular Asynergy by Echocardiography

The purpose of this study was to determnie if echocardiography could detect left ventricular asynergy. Forty-eight patients underwent selective coronary arteriography and cineventriculography for the evaluation of chest pain. Four patients were studied twice: three before and after myocardial revascularization and one before and after an intervening myocardial infarction. Echocardiographic M-mode scans were registered on a strip chart as the left ventricle was scanned with an ultrasonic beam from the aortic root to the region of the posterior papillary muscle approximately 18 hrs prior to the catheterization studies. Ten of the forty-eight patients had no evidence of coronary artery disease. All ten patients had normal ventriculograms in right anterior oblique projection and their echocardiographic scans showed all areas of the left ventricular posterior wall endocardium to move anteriorly 0.9-1.4 cm (mean 1.2 cm) and all parts of the left side of the interventricular septum to move posteriorly 0.3-0.8 cm (mean 0.5 cm) during systole. The 38 patients with significant obstructive coronary artery disease had a total of 42 studies; 25 of these studies showed left ventricular asynergy on the ventriculogram taken in right anterior oblique. The echocardiograms associated with all but one of these studies demonstrating left ventricular asynergy had abnormal motion of some part of the interventricular septum and/or left ventricular posterior wall. Seventeen studies in patients with significant coronary artery disease did not exhibit left ventricular asynergy on the ventriculogram but eight of these studies were associated with distinctly abnormal echocardiograms. None of the ten patients with significant coronary artery disease and normal echocardiograms had evidence of transmural infarction on their electrocardiograms. Echocardiographic abnormalities correlated with the anatomic area predicted by the myocardial infarction pattern on the electrocardiogram in 18 of 20 patients. All patients demonstrating abnormal echographic interventricular septal motion had a significant obstructive lesion in the left anterior descending coronary artery. In the absence of significant involvement of the left anterior descending coronary artery, echographically recorded interventricular septal motion was invariably normal. On the other hand, eight patients had significant obstruction in their left anterior descending coronary artery and their echographic interventricular septal motion was normal. The results of this correlative study indicate that M-mode echocardiographic scans can detect left ventricular asynergy and may possibly predict regional myocardial involvement in coronary artery disease.