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Left ventricular asynergy score as an indicator of previous myocardial infarction
Insights
Left ventricular asynergy, measured by the left ventricular motion score (LVMS) from cinecardioangiography, accurately detects previous myocardial infarction (MI) in coronary heart disease (CHD) patients. This method shows accuracy comparable to autopsy findings.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Cardiac Electrophysiology
Background:
- Coronary heart disease (CHD) diagnosis often relies on identifying previous myocardial infarction (MI).
- Electrocardiography (ECG) and patient history are common methods for detecting prior MI.
- Assessing left ventricular wall motion abnormalities provides further insight into cardiac function post-MI.
Purpose of the Study:
- To evaluate the accuracy of left ventricular asynergy, quantified by the left ventricular motion score (LVMS), in diagnosing previous myocardial infarction (MI) in patients with coronary heart disease (CHD).
- To compare the diagnostic performance of LVMS derived from cinecardioangiography with traditional ECG findings and autopsy results for previous MI detection.
Main Methods:
- Sixty-eight CHD patients underwent ECG and cinecardioangiography.
- A semiquantitative left ventricular motion score (LVMS) was developed to assess asynergy.
- Receiver Operating Characteristic (ROC) analysis was used to determine decision thresholds for ECG changes and asynergy in diagnosing previous MI.
Main Results:
- Higher LVMS values correlated with specific ECG changes indicative of previous MI.
- Unspecific or absent ECG changes were associated with lower LVMS values.
- The accuracy of LVMS in detecting previous MI was found to be comparable, and potentially superior, to traditional autopsy findings.
Conclusions:
- Left ventricular asynergy, assessed via LVMS from cinecardioangiography, is a reliable indicator of previous myocardial infarction in CHD patients.
- The LVMS method offers diagnostic accuracy for previous MI and myocardial fibrosis that is at least comparable to autopsy.
- This imaging-based scoring system enhances the non-invasive detection of myocardial damage in coronary heart disease.
Abstract:
Sixty-eight patients with coronary heart disease (CHD) i.e. a history of angina of effort and/or previous 'possible infarction' were examined inter alia with ECG and cinecardioangiography. A system of scoring was designed which allowed a semiquantitative estimate of the left ventricular asynergy from cinecardioangiography--the left ventricular motion score (LVMS). The LVMS was associated with the presence of a previous myocardial infarction (MI), as indicated by the history and ECG findings. The ECG changes specific for a previous MI were associated with high LVMS values and unspecific or absent ECG changes with low LVMS values. Decision thresholds for ECG changes and asynergy in diagnosing a previous MI were evaluated by means of a ROC analysis. The accuracy of ECG in detecting a previous MI was slightly higher when asynergy indicated a 'true MI' than when autopsy result did so in a comparable group. Therefore the accuracy of asynergy (LVMS greater than or equal to 1) in detecting a previous MI or myocardial fibrosis in patients with CHD should be at least comparable with that of autopsy (scar greater than 1 cm).