EVALUATION OF POSTMYOCARDIAL INFARCTION REGIONAL AND GLOBAL LEFT-VENTRICULAR FUNCTION BY MONOPLANE VENTRICULOGRAPHY - SUPERIORITY OF RIGHT VERSUS LEFT ANTERIOR OBLIQUE PROJECTION AT ANY INFARCT LOCATION

Objectives To study the significance of serial quantitative regional w all motion analysis, volumes, and ejection fraction findings as well a s their prognostic implications derived from cineventriculography in 3 0 degrees right anterior oblique (RAG) projection in comparison with 6 0 degrees left anterior oblique (LAG) projection in postmyocardial inf arction patients. Ventriculographic left ventricular parameters are ac cepted surrogates of mortality in myocardial infarction. Nowadays, in contrast to a biplanar approach in most institutions and clinical tria ls, the investigation is reduced to monoplanar ventriculography. Howev er, it is not known whether the relevance of the two established proje ctions might differ in different infarct topographies. Design and meth ods Two hundred and six consecutive patients with acute myocardial inf arction (infarct duration <6 h) were treated with streptokinase (group I, n = 103) and allocated randomly additional percutaneous translumin al coronary angioplasty (group II, n = 103). Biplanar cineventriculogr aphy studies were performed at the acute stage, before discharge, and 6 months after discharge from hospital. Results Regional wall motion a nalysis (using an algorithm of fixed radiants) documented larger hypok inetic areas and intensities on RAO than it did on LAO projections, wh ereby infarct size and its improvement (stunned myocardium) was displa yed more comprehensively, and a higher predictive power for survival ( P = 0.0002 versus NS) was shown in anterior and inferior infarcts. No advantage of the LAO projection could be detected for evaluation of la teral infarcts due to circumflex coronary artery thrombosis either, Th e predictive power of the global function (ejection fraction; the algo rithm of disc summation method) established by RAO projection (P = 0.0 07) was superior to that of LAO projection (P = 0.03), Enlargement of volumes (left ventricular remodeling) could be documented significantl y only by the RAO projection; the LAO projection failed to do so. Grou ps I and II did not differ in any respect. Conclusions The RAO project ion has excellent diagnostic and predictive power at any infarct locat ion. In contrast, additional LAO projection provides little informatio n that cannot be obtained reliably from the RAO projection.