OBSERVATIONS OF THE RELATIONSHIP BETWEEN LEFT-VENTRICULAR ANEURYSM AND ST-SEGMENT ELEVATION IN PATIENTS WITH A FIRST ACUTE ANTERIOR Q-WAVE MYOCARDIAL-INFARCTION
Sk. Bhatnagar, OBSERVATIONS OF THE RELATIONSHIP BETWEEN LEFT-VENTRICULAR ANEURYSM AND ST-SEGMENT ELEVATION IN PATIENTS WITH A FIRST ACUTE ANTERIOR Q-WAVE MYOCARDIAL-INFARCTION, European heart journal, 15(11), 1994, pp. 1500-1504
Seventy-eight consecutive survivors of a first acute anterior Q wave m
yocardial infarction (AMI) underwent two-dimensional echocardiography
(2D echo), colour Doppler echo and radionuclide angiography (RNA) for
the diagnosis of left ventricular (LV) anteroapical aneurysm, in order
to study the relationship of this complication to precordial ST segme
nt elevation in these patients. The ST elevation (mm) in lead V-2, the
maximum ST elevation in V-1-V-6 and the sum of ST elevation in V-1 to
V-6 were calculated. LV aneurysm was present in 19 patients by 2D ech
o, of whom 12 had a paradoxical systolic flow pattern (red and outward
towards the transducer) at the apex. There was no difference between
the mean ST elevation in V-2 or rite maximum ST elevation in V-1-V-6 i
n patients with and without an aneurysm, although the sum of ST elevat
ions in V-1 to V-6 was higher in the former group (P<0.01). ST elevati
on of patients with and without paradoxical systolic flow also did not
differe significantly. Wall motion abnormality (akinesis and dyskines
is) by 2D echo in the anterior wall was seen in 74% of patients with a
nd 36% of patients without an aneurysm (P<0.005), and in the septal re
gion in 63% and 47% of respective patients (P-NS). There was no differ
ence between the magnitude of ST elevation in subgroups of patients wi
th ejection fraction (EF) less than or equal to 30% to greater than or
equal to 40%, but the mean EF of patients with (23 +/- 2.1%) and with
out a LV aneurysm (34 +/- 1.3%) differed (P<0.001). It is concluded th
at precordial ST segment elevation does not clearly aid in the diagnos
is of an anteroapical LV aneurysm. It is related to akinesis and dyski
nesis in anterior and septal regions inherent in patients with AMI and
does not indicate impaired LV function.