VALUE OF TRANSTHORACIC 2-DIMENSIONAL ECHOCARDIOGRAPHY IN PREDICTING VIABILITY IN PATIENTS WITH HEALED Q-WAVE ANTERIOR WALL MYOCARDIAL-INFARCTION

The role of transthoracic echocardiography as a predictor of recovery after revascularization has not yet been established. Two-dimensional echocardiography was performed in 15 patients with a healed anterior w all myocardial infarction and severe, isolated stenosis of the left an terior descending coronary artery before, and 3 to 6 months after angi ographically confirmed successful revascularization. The asynergic seg ments were classified into 2 groups according to 2 different echocardi ographic patterns: those showing a normal acoustic reflectance with no rmal end-diastolic thickness (pattern A segments) and those showing an increase in acoustic reflectance and reduced end-diastolic thickness (pattern 3 segments). We hypothesized that pattern A segments were mor e likely to recover (viable myocardium) and that pattern B segments we re consistent with irreversibility. A total of 240 segments in the 15 patients were evaluated before ana after revascularization. Sixty-seve n segments were asynergic; of these, 52 were judged to have pattern A and 15 pattern B. Of the 52 pattern A segments, 27 were hypokinetic an d 25 akinetic. All of the pattern B segments were akinetic (n = 9) or dyskinetic (n = 6). Pattern A was predictive of postoperative recovery in 39 of 52 segments (75%) (p < 0.0001); pattern B was predictive of irreversibly damaged tissue in 13 of 15 segments (87%) (p < 0.0001). T hus, in patients with healed anterior wall myocardial infarction, rest ing transthoracic echocardiography is a simple and reliable predictor of the behavior of asynergic segments after revascularization.