QUANTITATION OF MYOCARDIAL DYSFUNCTION IN ISCHEMIC-HEART-DISEASE BY ECHOCARDIOGRAPHIC ENDOCARDIAL SURFACE MAPPING - CORRELATION WITH HEMODYNAMIC STATUS

Autopsy studies have suggested that infarction of >35% of the myocardi um is associated with cardiogenic shock. However, the relation between the extent of myocardial dysfunction and hemodynamic status has not b een defined in patients in vivo. This study investigated, in patients with short-term and chronic left ventricular dysfunction, the relation between hemodynamic status and the extent of regional dyssynergia mea sured by two-dimensional echocardiography with quantitative endocardia l surface mapping. Sixty patients were classified into hemodynamic gro ups by pulmonary capillary wedge pressure and cardiac index. Two-dimen sional echocardiograms were used to calculate left ventricular endocar dial surface area index (ESAi), abnormal wall motion index (AWMi), per centage myocardial dysfunction (%MD), and number of wall motion abnorm alities. All patients in class 4 (high pulmonary capillary wedge press ure and low cardiac index had greater than or equal to 60% MD. With un ivariate analysis, hemodynamic class correlated with ESAi, AWMi, %MD, the number of wall motion abnormalities, and two clinical variables (n umber of infarctions and use of diuretic agents). By stepwise linear r egression, only AWMi and the number of infarctions were independently predictive of hemodynamic status.