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(Circulation. 2000;102:e25.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Ventricular Electromechanical Mapping in Stunned Myocardium

Yoshiki Kobayashi, MD; Kenei Shimada, MD; Hiroyuki Yamagishi, MD; Shouichi Ehara, MD; Yasuhiro Nakamura, MD; Kazuhide Takeuchi, MD; Junichi Yoshikawa, MD

From the First Department of Internal Medicine, Osaka City University, Osaka, Japan.

Correspondence to Yoshiki Kobayashi, MD, First Department of Internal Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. E-mail kobayashiy{at}med.osaka-cu.ac.jp

A 62-year-old woman with a history of vasospastic angina presented to the emergency room with chest pain. The ECG showed ST-segment elevation in leads V₃ through V₆. The transthoracic echocardiogram revealed an akinetic left ventricular (LV) apical wall. The coronary angiogram on admission demonstrated normal coronary arteries.

Two weeks later, resting ^99mTc-tetrofosmin myocardial single photon emission CT (SPECT) imaging revealed no perfusion defect (Figure 1). The dobutamine stress echocardiogram showed that LV apical wall contractility increased from hypokinetic to hyperkinetic with a low dose of dobutamine. LV electromechanical mapping demonstrated normal unipolar voltage potentials (Figure 2) and reduction of local endocardial shortening (Figure 3) in the LV apical wall.

View larger version (105K): [in this window] [in a new window]   Figure 1. Resting 99mTc-tetrofosmin myocardial SPECT imaging demonstrates no perfusion defect. Vertical long-axis (left) and horizontal long-axis (right) images.

View larger version (28K): [in this window] [in a new window]   Figure 2. Right anterior oblique (left) and left anterior oblique (right) views of LV unipolar voltage maps demonstrating normal unipolar voltage potentials throughout LV except for mitral annulus zones. Color scale is set from 2.9 mV (red) to 19.1 mV (blue/purple).

View larger version (30K): [in this window] [in a new window]   Figure 3. Right anterior oblique (left) and left anterior oblique (right) views of local shortening maps, detecting extent of LV contractility, with hypokinetic zone in apical wall. Color scale is set from 6% (red) to 12% (blue/purple).

The LV electromechanical mapping procedure thus permitted online detection of stunned myocardium in the catheterization laboratory.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kobayashi, Y. Articles by Yoshikawa, J. Search for Related Content PubMed Articles by Kobayashi, Y. Articles by Yoshikawa, J. Related Collections Cardiovascular imaging agents/Techniques Other diagnostic testing Acute myocardial infarction