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  • Title: [Reversible asynergy in acute transmural myocardial infarction: evaluations of patients with inferior infarction].
    Author: Hamano Y, Minamino T, Fujii K, Ueki N, Ohnishi S, Yasui K, Matsumoto M, Inoue M, Kamada T.
    Journal: J Cardiogr; 1985 Sep; 15(3):613-24. PubMed ID: 3837057.
    Abstract:
    To evaluate the significance of chronological changes in wall motion abnormalities, echocardiography was performed for 46 patients with acute transmural inferior myocardial infarction without previous infarction or complications. Asynergy was analyzed by two-dimensional echocardiography (2-D Echo) on the third day (acute stage) and the 28th day (convalescent stage) after the onset of infarction. Asynergy was quantitatively estimated by dividing the left ventricle into 17 segments. The degree of asynergy was graded on a four-point scale as dyskinesis = 3, akinesis = 2, hypokinesis = 1, and normokinesis = 0. The total wall motion score (TWMS) was calculated on the both days. Improvement of asynergy was observed in 39 cases (84.8%). Among them, both the extent and degree of asynergy were improved in 17 cases (37.0%). In 10 cases (21.7%) the extent of asynergy was reduced. In the remaining 12 cases (26.1%), only the degree of asynergy was decreased. Concerning the relationship between the degree of asynergy on the 3rd day and the subsequent alteration of asynergy on the 28th day, two of four dyskinetic segments still had dyskinesis, and the other two reverted to akinesis. Among 156 akinetic segments, 80 did not change, but 58 reverted to hypokinesis and 18, to normokinesis. Among 82 hypokinetic segments, 48 did not change, but 34 became normal. The relationship between severity of asynergy on the third day indicated by the total wall motion score (TWMS 3rd) and the improvement in the score on the 28th day (TWMS 28th) was investigated in three patient groups: group-A (n = 19) showed TWMS 3rd greater than 9; group-B (n = 22), 9 greater than or equal to TWMS 3rd greater than or equal to 3; group-C (n = 5), TWMS 3rd less than 3. The frequency of "no improvement" was slightly higher in the group-C (62.5%) than in the group-A (52.1%) and in the group-B (56.4%). On comparison, improvement of asynergy was observed in the group-A in 47.9% and in the group-B in 43.6%, but the rate of resolution of asynergy was higher in group-B (53.6%) than in the group-A (40.3%). In the group-C, there was no case of significant coronary artery stenosis greater than 75% in diameter and sigma CPK was smaller than in the other two groups (p less than 0.005).(ABSTRACT TRUNCATED AT 400 WORDS)
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