Clinicopathological characteristics of left ventricular myocardium with transient asynergy - Report of three cases

The aim of the present retrospective study was to clarify the histopatholog ic substrates of left ventricular myocardium with transient asynergy due to acute ischemic insult in man. Three patients who had had prolonged chest pain, new abnormal Q waves and n ew ST segment elevation were studied. There was no significant elevation of serum creatine phosphokinase activity in two of the three patients. Echoca rdiograms on admission or the next day showed severe hypokinetic or akineti c motion and thinning of the anteroseptal and apical portions of the left v entricle and regional dilatation of the same portions. Disappearance of the abnormal Q waves, ST segment elevation resolution, and early T wave invers ion were observed later. Complete improvement of the echocardiographic abno rmalities was confirmed after a few weeks in all patients. Manifest ischemic lesions of subendocardial scars of the anteroseptal regio n of the left ventricle were detected in only one of the three casts by gro ss examination. However, on microscopic examination, islands of necrotic my ocytes were interspersed with islands or viable cells throughout the jeopar dized region in one case, although the scattered necrotic foci were restric ted to the subendocardium and the trabeculae. Normal myocardium and subendo cardial scars were observed in the other two cases. In conclusion, left ventricular myocardium with transient asynergy, detecte d clinically during acute ischemic attack, consists of normal myocardium or small ischemic lesions primarily in the subendocardium.