Assessment of left ventricular inferior wall motion activity by gated radionuclide ventriculography may
be limited using the anterior view because of right ventricular interference. This study compared the assessment of
inferior wall motion using the anterior view with the 70° left posterior oblique view in 274 patients in which
electrocardiograms were also available. The anterior view was inadequate for inferior wall evaluation in 34% of the
patients due to right ventricular overlap, while the inferior wall was adequately visualized in all patients using the
70° left posterior oblique view. Of those patients with right ventricular interference, inferior wall motion abnormalities
were noted in 71 % using the 70° left posterior oblique view. Evaluation of electrocardiograms demonstrated
that inferior Q-wave infarctions were more prevalent in patients with right ventricular interference than in patients
with no interference. These results suggest that the 70° left posterior oblique view aids in the evaluation of inferior
wall motion, particularly in patients suspected of inferior infarction or right ventricular disease.
Persistent precordial S-T segment elevation has been assumed to be evidence of left ventricular aneurysm.
To evaluate this hypothesis, we examined the electrocardiograms and radionuclide ventriculograms of 374 consecutive patients referred to the nuclear cardiology laboratory for evaluation of ventricular function. Patients with major intraventricular conduction abnormalities, left and right bundle branch block, pacemaker-dependent rhythms and inferior wall aneurysms were excluded. Among 40 patients with persistent S-T segment elevation, 29 (73%) had left ventricular aneurysm, whereas aneurysm was present in only 21 (6%) of 334 patients without S-T segment elevation. There were 70 patients with Q wave anterior myocardial infarction. Among those patients with S-T segment elevation, 74% had left ventricular aneurysm, 47% had dyskinetic wall motion and 94% had akinetic wall motion. Among those patients without S-T segment elevation, 25% had left ventricular aneurysm, 8% had dyskinesis and 58% had akinesis. We conclude that the presence of persistent S-T segment elevation on the electrocardiogram is predictive of severe forms of wall motion abnormalities of the left ventricle including aneurysm.
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