[Early diagnosis of postinfarction ventricular aneurysm. Value of contrast scintigraphy]

Early diagnosis of a ventricular aneurysm after myocardial infarction may provide a valuable means of preventing certain complications. We studied 55 patients with acute myocardial infarction on the 8th day by Technetium 99 angioscintigraphy with study of wall motion and ejection fraction at equilibrium. The results were compared with left ventriculography performed three months after infarction. Angioscintigraphy demonstrated 17 cases of dyskinesia, 16 cases of hypokinesia, and 22 cases of akinesia, divided into two subgroups depending on whether the ejection fraction was lower (n = 11) or higher than 40% (n = 11). Contrast angiography at 3 months confirmed the presence of 27 aneurysms, 17 akinetic plaques and 11 cases of hypokinesia. Comparison between the two series of investigations showed excellent correlations: in the group of dyskinesia (17 cases) an aneurysm was confirmed in 15 cases; in the group of hypokinesia (16 cases) only one aneurysm was demonstrated by the reference angiography. The results were less uniform in the group with akinesia. In the subgroup with a low ejection fraction, 9 out of 11 cases progressed to aneurysm and, in retrospect, should be considered as likely aneurysms. There were only 2 aneurysms (2/11) in the subgroup with localised akinesia and a high ejection fraction. The overall results suggest that angioscintigraphy at the 8th day of myocardial infarction is a reliable means of detecting left ventricular aneurysm; in cases of dyskinesia or widespread akinesia with an ejection fraction of less than 40% the presence of an aneurysm was confirmed in 24 out of 28 patients (86%).(ABSTRACT TRUNCATED AT 250 WORDS)