Segmental wall motion abnormalities in the absence of clinically documented myocardial infarction: Clinical significance and evidence of hibernating myocardium

Stephen J. Lewis, Stephen Sawada, Thomas Ryan, Douglas S. Segar, William F. Armstrong, Harvey Feigenbaum

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

To determine the frequency and significance of left ventricular wall motion abnormalities in patients without clinical evidence of myocardial infarction, we reviewed the two-dimensional echocardiograms of 252 patients who had no history or electrocardiographic evidence of myocardial infarction and who subsequently underwent coronary angiography. Seventy-seven patients (31%) had one or more segmental wall motion abnormalities. Sixty-six of the 77 patients (86%) had significant coronary artery disease (≥50% luminal diameter stenosis). Seventy-four percent of the patients with coronary artery disease had multivessel disease. The left ventricle was divided into anterior and posterior regions. In the 66 patients, there were 77 separate regions with wall motion abnormalities (49 hypokinesis, 22 akinesis, 6 dyskinesis), including 60 regions (78%) supplied by coronary vessels with ≥70% stenosis. Thirty-two patients underwent coronary artery bypass surgery or percutaneous transluminal coronary angioplasty. Follow-up echocardiograms were obtained in 19 patients who had wall motion abnormatlies involving 22 regions. Twenty of the 22 regions were revascularized. Wall motion improved in 17 of 20 regions (85%) and returned to normal in 15 regions (75%). We conclude that segmental wall motion abnormalities may be detected by echocardiography in up to one third of patients evaluated for suspected coronary artery disease without documented myocardial infarction. These abnormalities are associated with a high likelihood of multivessel disease as well as with significant narrowing of the artery supplying the region demonstrating abnormal wall motion. Improvement in segmental wall motion abnormalities after revascularization suggests that these areas represent regions of hibernating myocardium.

Original languageEnglish
Pages (from-to)1088-1094
Number of pages7
JournalAmerican Heart Journal
Volume121
Issue number4 PART 1
DOIs
StatePublished - 1991

Fingerprint

Myocardium
Myocardial Infarction
Coronary Artery Disease
Pathologic Constriction
Coronary Balloon Angioplasty
Coronary Angiography
Coronary Artery Bypass
Heart Ventricles
Echocardiography
Coronary Vessels
Arteries
History

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Segmental wall motion abnormalities in the absence of clinically documented myocardial infarction : Clinical significance and evidence of hibernating myocardium. / Lewis, Stephen J.; Sawada, Stephen; Ryan, Thomas; Segar, Douglas S.; Armstrong, William F.; Feigenbaum, Harvey.

In: American Heart Journal, Vol. 121, No. 4 PART 1, 1991, p. 1088-1094.

Research output: Contribution to journalArticle

@article{e5ba1722346b43909725cdcbf687475b,
title = "Segmental wall motion abnormalities in the absence of clinically documented myocardial infarction: Clinical significance and evidence of hibernating myocardium",
abstract = "To determine the frequency and significance of left ventricular wall motion abnormalities in patients without clinical evidence of myocardial infarction, we reviewed the two-dimensional echocardiograms of 252 patients who had no history or electrocardiographic evidence of myocardial infarction and who subsequently underwent coronary angiography. Seventy-seven patients (31{\%}) had one or more segmental wall motion abnormalities. Sixty-six of the 77 patients (86{\%}) had significant coronary artery disease (≥50{\%} luminal diameter stenosis). Seventy-four percent of the patients with coronary artery disease had multivessel disease. The left ventricle was divided into anterior and posterior regions. In the 66 patients, there were 77 separate regions with wall motion abnormalities (49 hypokinesis, 22 akinesis, 6 dyskinesis), including 60 regions (78{\%}) supplied by coronary vessels with ≥70{\%} stenosis. Thirty-two patients underwent coronary artery bypass surgery or percutaneous transluminal coronary angioplasty. Follow-up echocardiograms were obtained in 19 patients who had wall motion abnormatlies involving 22 regions. Twenty of the 22 regions were revascularized. Wall motion improved in 17 of 20 regions (85{\%}) and returned to normal in 15 regions (75{\%}). We conclude that segmental wall motion abnormalities may be detected by echocardiography in up to one third of patients evaluated for suspected coronary artery disease without documented myocardial infarction. These abnormalities are associated with a high likelihood of multivessel disease as well as with significant narrowing of the artery supplying the region demonstrating abnormal wall motion. Improvement in segmental wall motion abnormalities after revascularization suggests that these areas represent regions of hibernating myocardium.",
author = "Lewis, {Stephen J.} and Stephen Sawada and Thomas Ryan and Segar, {Douglas S.} and Armstrong, {William F.} and Harvey Feigenbaum",
year = "1991",
doi = "10.1016/0002-8703(91)90666-6",
language = "English",
volume = "121",
pages = "1088--1094",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4 PART 1",

}

TY - JOUR

T1 - Segmental wall motion abnormalities in the absence of clinically documented myocardial infarction

T2 - Clinical significance and evidence of hibernating myocardium

AU - Lewis, Stephen J.

AU - Sawada, Stephen

AU - Ryan, Thomas

AU - Segar, Douglas S.

AU - Armstrong, William F.

AU - Feigenbaum, Harvey

PY - 1991

Y1 - 1991

N2 - To determine the frequency and significance of left ventricular wall motion abnormalities in patients without clinical evidence of myocardial infarction, we reviewed the two-dimensional echocardiograms of 252 patients who had no history or electrocardiographic evidence of myocardial infarction and who subsequently underwent coronary angiography. Seventy-seven patients (31%) had one or more segmental wall motion abnormalities. Sixty-six of the 77 patients (86%) had significant coronary artery disease (≥50% luminal diameter stenosis). Seventy-four percent of the patients with coronary artery disease had multivessel disease. The left ventricle was divided into anterior and posterior regions. In the 66 patients, there were 77 separate regions with wall motion abnormalities (49 hypokinesis, 22 akinesis, 6 dyskinesis), including 60 regions (78%) supplied by coronary vessels with ≥70% stenosis. Thirty-two patients underwent coronary artery bypass surgery or percutaneous transluminal coronary angioplasty. Follow-up echocardiograms were obtained in 19 patients who had wall motion abnormatlies involving 22 regions. Twenty of the 22 regions were revascularized. Wall motion improved in 17 of 20 regions (85%) and returned to normal in 15 regions (75%). We conclude that segmental wall motion abnormalities may be detected by echocardiography in up to one third of patients evaluated for suspected coronary artery disease without documented myocardial infarction. These abnormalities are associated with a high likelihood of multivessel disease as well as with significant narrowing of the artery supplying the region demonstrating abnormal wall motion. Improvement in segmental wall motion abnormalities after revascularization suggests that these areas represent regions of hibernating myocardium.

AB - To determine the frequency and significance of left ventricular wall motion abnormalities in patients without clinical evidence of myocardial infarction, we reviewed the two-dimensional echocardiograms of 252 patients who had no history or electrocardiographic evidence of myocardial infarction and who subsequently underwent coronary angiography. Seventy-seven patients (31%) had one or more segmental wall motion abnormalities. Sixty-six of the 77 patients (86%) had significant coronary artery disease (≥50% luminal diameter stenosis). Seventy-four percent of the patients with coronary artery disease had multivessel disease. The left ventricle was divided into anterior and posterior regions. In the 66 patients, there were 77 separate regions with wall motion abnormalities (49 hypokinesis, 22 akinesis, 6 dyskinesis), including 60 regions (78%) supplied by coronary vessels with ≥70% stenosis. Thirty-two patients underwent coronary artery bypass surgery or percutaneous transluminal coronary angioplasty. Follow-up echocardiograms were obtained in 19 patients who had wall motion abnormatlies involving 22 regions. Twenty of the 22 regions were revascularized. Wall motion improved in 17 of 20 regions (85%) and returned to normal in 15 regions (75%). We conclude that segmental wall motion abnormalities may be detected by echocardiography in up to one third of patients evaluated for suspected coronary artery disease without documented myocardial infarction. These abnormalities are associated with a high likelihood of multivessel disease as well as with significant narrowing of the artery supplying the region demonstrating abnormal wall motion. Improvement in segmental wall motion abnormalities after revascularization suggests that these areas represent regions of hibernating myocardium.

UR - http://www.scopus.com/inward/record.url?scp=0026026130&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026026130&partnerID=8YFLogxK

U2 - 10.1016/0002-8703(91)90666-6

DO - 10.1016/0002-8703(91)90666-6

M3 - Article

C2 - 2008830

AN - SCOPUS:0026026130

VL - 121

SP - 1088

EP - 1094

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 4 PART 1

ER -