Echocardiographic diagnosis of left anterior descending coronary artery disease

In order to evaluate the ability of the echocardiogram to detect and localize left main or left anterior descending (LAD) coronary artery lesions, 43 patients were studied. The systolic excursion of the left side of the septum and the ratio of posterior wall to septal excursion were measured. Seventeen patients had no LAD lesions; all had systolic septal excursion of 3 mm or greater. Twelve patients with septal excursion of 2 mm or less all had left main or LAD lesions, but 14 other patients with LAD lesions had septal excursions of 3 mm or greater. Nine of 16 patients with LAD lesions proximal to the first septal branch had reduced or absent septal excursion, as did three of ten with LAD lesions distal to the first septal branch. In a setting of coronary artery disease reduced or absent septal motion on echocardiography suggests involvement of the left main or left anterior descending coronary. However, the technique is relatively insensitive, with 54% of the LAD patients having normal septal motion.

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confidence: 99%

Interventricular septal motion in patients with proximal and distal left anterior descending coronary artery lesions.

Gordon¹,

Kerber²

1977

“…There is a gross perfusion defect of the interventricular septum consistent with complete absence of septal perfusion. This image is typical of the 10 Figure 7 shows a perfusion scan in a patient in whom the interventricular septum was totally perfused by collaterals from the right coronary artery. Even though the septum was not being supplied from the anterior descending artery, collateral flow from the right coronary artery was adequate to maintain normal septal motion and in such cases we consider septal perfusion to be present.…”

Section: Resultsmentioning

confidence: 92%

“…On the other hand, the echocardiogram can provide useful information regarding the interventricular septum, a structure which is not easily evaluated by conventional angiographic techniques."' 12 An important and common cause of abnormal echocardiographic septal motion (AESM) is high grade obstruction of the left anterior descending artery.5' 10,13 This abnormality of the septum when seen in the presence of significant obstruction of the left anterior descending would seem to imply myocardial ischemia and/or infarction or fibrosis of the septum. A recent report which includes pathological studies related septal thinning to scarring of the septum.…”

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confidence: 99%

The relationship between abnormal echocardiographic septal motion and myocardial perfusion in patients with significant obstruction of the left anterior descending artery.

Kolibash¹,

Beaver²,

Fulkerson³

et al. 1977

This study assesses the relationship between segmental myocardial function and coronary perfusion in patients with high-grade stenosis of the left anterior descending artery. Twenty-five patients with critical lesions (> 70%) were divided into two groups according to the absence or presence of normal echocardiographic septal motion. Twelve patients had abnormal echocardiographic septal motion (AESM) and 13 patients had normal septal motion. Septal perfusion was evaluated by intracoronary injections of radiolabeled macroaggregated albumin (MAA) particles. Of the parameters analyzed abnormal septal perfusion was best related to AESM. Among the 12 patients with AESM, ten had absent resting septal perfusion. Of the 13 patients with normal septal ECHOCARDIOGRAPHY HAS NOW BECOME a useful and accepted noninvasive procedure for evaluating left ventricular performance.' Although the procedure has been most helpful in assessing left ventricular function when the ventricle is diffusely diseased, the echocardiogram is also of proven benefit in defining abnormal contractility in patients with coronary artery disease.8 '0 However, since all segments of the ventricle are not accessible by echocardiography and since coronary disease may produce segmental ventricular dysfunction, it is not always possible to detect all diseased segments of the ventricle. On the other hand, the echocardiogram can provide useful information regarding the interventricular septum, a structure which is not easily evaluated by conventional angiographic techniques."' 12 An important and common cause of abnormal echocardiographic septal motion (AESM) is high grade obstruction of the left anterior descending artery.5' 10, 13 This abnormality of the septum when seen in the presence of significant obstruction of the left anterior descending would seem to imply myocardial ischemia and/or infarction or fibrosis of the septum. A recent report which includes pathological studies related septal thinning to scarring of the septum.'2 Some authors have further suggested that AESM implies not only a critical left anterior descending lesion, but that the lesion is proximal to the first septal perforator branch.10 13Despite the usefulness of coronary angiography in defining the presence of significant obstruction of the major coronary arteries, the procedure does not allow visualization of small vessels and therefore does not provide complete information concerning resting myocardial perfusion. motion, only two had abnormal septal perfusion. Septal width was also significantly thinner in patients with AESM. When angiographic collateralization was associated with septal perfusion as detected by injection of MAA into the right coronary artery, normal septal motion was present (five patients). When no septal perfusion resulted from right coronary injection, even though collaterals were seen angiographically, AESM was found (four patients). Thus, in patients with severe left anterior descending stenosis the presence of abnormal echocardiographic septal motion strongly sug...

“…'-8 In patients with severe obstruction of the LAD, abnormal IVS motion may be seen by "conventional echocardiography" by placing the transducer along the left sternal border.3' 6 [8][9][10] However, this does not indicate that LAD lesions always lead to abnormality of the IVS motion. Jacobs et al, 5 Gordon and Kerber,"1 and Kolibash et al '2 have documented that about half of their patients with severe lesions of the LAD had normal echocardiographic IVS motion.…”

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confidence: 99%

Esophageal echocardiographic left ventricular anterolateral wall motion in normal subjects and patients with coronary artery disease.

Matsuzaki¹,

Matsuda²,

Ikee³

et al. 1981

SUMMARY Esophageal echocardiography was developed for recording left ventricular anterolateral wall (LVAW) echocardiograms and was applied clinically to 14 normal subjects and 21 patients with coronary artery disease. LVAW echocardiograms were obtained satisfactorily in 11 of 14 normal subjects (75%) and 20 of 21 patients (95%) with coronary artery disease. LVAW echocardiograms were obtained by conventional anterior echocardiography in eight of 21 patients (38%) with coronary artery disease. In 11 normal subjects, LVAW excursion averaged 10.8 ± 1.7 mm (range 8-13 mm); mean systolic velocity ranged from 28-41 mm/sec (mean 34.3 ± 5.2 mm/sec); and diastolic wall thickness ranged from 9-12.5 mm (mean 11.2 + 0.7 mm). In 20 patients with coronary artery disease, LVAW motion obtained by esophageal echocardiography was classified into five groups according to the excursion, and the findings were in good agreement (80%) with those obtained by left ventriculography. Classification of LVAW motion by conventional echocardiography agreed with that of left ventriculography in only three of eight patients, although all eight patients had abnormal LVAW motion by the conventional method. In all patients except one, whose LVAW echocardiograms were obtained by conventional echocardiography, excursion was much less than that obtained by esophageal echocardiography. We conclude that the projection of an ultrasonic beam from the intraesophageal transducer is a better approach for accurate measurement of LVAW motion.ABNORMAL left ventricular wall motion occurs in some patients with severe coronary artery disease. The left ventricular anterior wall (LVAW) and interventricular septum (IVS) are supplied by the left anterior descending coronary artery (LAD), and generally, motion of those walls is impaired if severe stenosis of this artery causes ischemia.Echocardiography is one of the most useful noninvasive procedures for evaluating left ventricular regional wall motion.'-8 In patients with severe obstruction of the LAD, abnormal IVS motion may be seen by "conventional echocardiography" by placing the transducer along the left sternal border.