Circulation, Vol 73, 1360-1368, Copyright © 1986 by American Heart Association
T Force, A Kemper, L Perkins, M Gilfoil, C Cohen and AF Parisi
Analyses of regional left ventricular systolic wall motion or thickening
overestimate infarct size. We used quantitative two- dimensional
echocardiographic analysis of systolic thickening and contrast
two-dimensional echocardiography to evaluate causes for that
overestimation. The following possibilities were considered: "tethering,"
defined as dysfunction of contrast-enhancing myocardium adjacent to
ischemic or contrast-negative regions, and the role of standard center of
mass analysis algorithms, which may overestimate wall motion abnormalities
because of the axis shift produced by simultaneous systolic expansion of
the ischemic segment and systolic contraction of the nonischemic segment.
In the short-axis view in 12 animals, the echo contrast defect (ECD)
occupied 32 +/- 7% of the left ventricular circumference. Extent of
dysfunction by the center of mass analysis was 39 +/- 5% of the left
ventricular circumference and correlation with ECD size was .68 (SEE =
5.2%). Thus 8 +/- 6% of the circumference of the left ventricle was
assessed to be dysfunctional yet enhanced with contrast. Tethering
accounted for only half of this (4 +/- 4% of left ventricular
circumference) and involved less than 1 cm on either side of the ECD. The
remaining overestimation by the center of mass analysis correlated
significantly (r = .89, p less than .01) with the amount of systolic
expansion of the ECD. This expansion of the ECD (increase in angle
subtended by the ECD of 11 +/- 8%) was produced by the systolic shift in
the center of mass toward the dysfunctional segment from contraction of the
opposite, nonischemic segment.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Overestimation of infarct size by quantitative two-dimensional echocardiography: the role of tethering and of analytic procedures
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