Systolic thickening and thinning of the septum and posterior wall in patients with coronary artery disease, congestive cardiomyopathy, and atrial septal defect.

Abstract

SUMMARY Echocardiographic septal and posterior wall thicknesses and the percent change with systole were measured in 146 patients with the following diagnoses: acute myocardial infarction (40), chronic coronary artery disease (49), congestive cardiomyopathy (8), atrial septal defect (20), and no cardiac disease (29). Mean diastolic thicknesses for the groups of patients with coronary artery disease and congestive cardiomyopathy were not significantly different from normal although there were abnormal values for individual patients within each group. Mean diastolic thickness of the septum was greater than normal for the group with atrial septal defect (P < 0.02). Wall thinning with systole was SEGMENTAL ABNORMALITIES of left ventricular wall motion have been demonstrated echocardiographically in patients with angiographically demonstrated coronary artery obstruction" 2 and in patients with acute myocardial infarction.34 Motion in noninfarcted areas is often greater than normal.3 These studies suggest that the abnormal left ventricular echo motion in these patients is related to segmental differences in myocardial fiber shortening. Echo motion may also be affected by other factors such as 1) motion of the entire heart within the chest; 2) unloading during systole; 3) electrical conduction;5 6 4) relative diastolic volumes of the right and left ventricles;7' 8 and 5) cardiac surgery.9 On the basis of experimental data, Ross and Franklin have suggested that dynamic changes in wall thickness might be used to study regional changes in contractile function caused by ischemia.'0 Because systolic thickening may not be influenced by the variety of factors affecting wall motion, and may therefore be more specifically related to contractility, the present study was undertaken in order 1) to determine whether there are changes in echocardiographic wall thickening in humans with coronary artery disease; 2) to see if these changes might distinguish acute myocardial infarction from chronic coronary artery disease; and 3) to see if changes in systolic thickening are related to changes in wall motion.

Serial evaluation of myocardial thickening and thinning in acute experimental infarction: identification and quantification using two-dimensional echocardiography.

“…[1][2][3][4][5][6] The application of two-dimensional echocardiography (2-D echo) to the problem of acute myocardial infarction (AMI) poses an important challenge to the clinical cardiologist. Reports have emerged that infarcted areas can be detected from left ventricular (LV) wall motion abnormalities present by 2-D echo.7 I Most recently, several investigations suggest further that infarct size can be predicted, based on a comparison of the extent of wall motion abnormality to thallium-201 perfusion defects9 or to peak CK-MB serum enzyme activities.…”

Echoventriculography in acute myocardial infarction. IV. Infarct size and reliability by pathologic anatomic correlations

“…For instance, systolic wall motions at the center of infarctions were mostly paradoxical and systolic thickening was never seen. The latter finding is fundamental in differentiating ischemia and infarction from hypokinetic or even paradoxical regional wall motions caused by more physiological phenomena such as septal asynergy in the right ventricular volume overload (Corya et al, 1977), and in physically highly trained subjects (Nieminen, 1977a), from bundle-branch block, or simply due to the anterior mass motion of the whole heart seen normally in systole (McDonald et al, 1972). Loss of systolic thickening together with reduced or absent systolic motion amplitude is one of the characteristic forms of asynergy in experimental myocardial ischemia or infarction (Heikkila et al, 1972;Kerber and Marcus, 1978;Ross and Franklin, 1976;Sasayama et al, 1976).…”

Measurements of left ventricular wall thickness and systolic thickening by M mode echocardiography: Interobserver and intrapatient variability

“…In these studies the technique for measuring diastolic wall thickness has varied in timing from the maximum posterior deflection (1, 2, 4), to middiastole (14,19), to enddiastole (6), the latter being defined by the R wave of the simultaneously recorded electrocardiogram. We sought to differentiate the reproducibility of diastolic measurements at the onset of the P wave and the peak of the R wave.…”