Myocardial map derived from two-dimensional echocardiography: reproducible and standardized description of infarction...

The aim of this study was to improve the reproducibility and the standardization of the topographical assessment of myocardial infarctions in routine two-dimensional echocardiography. A myocardial map of the left ventricle was derived from a necropsy study of normal human hearts; interventricular grooves and papillary muscles were used as anatomical landmarks defining 16 segments with similar planimetered surfaces. A reporting sheet was prepared, with diagrams of standardized echo sections and with a map showing the position of the corresponding outlines. The echocardiographic method consisted in identifying on each section the regions without systolic thickening, and displaying the results on the map, until a coherent picture of the abnormal areas was obtained. Interobserver reproducibility was studied in 50 consecutive patients with prior myocardial infarction; segments were classified as fully abnormal, partly abnormal, non-visualized, and normal. Among the 800 segments there were 1% severe and 12% moderate discrepancies; discrepancies were significantly lower for segments with confrontation in two different sections intersecting on the map. A classification of infarction topographies was obtained in 100 consecutive patients; it was compared with the data of two reanalysable pathologic series from the literature; a similar presentation of the results showed similar typical patterns of myocardial involvement, for which a nomenclature was proposed. A myocardial map may be used to provide a simple and reproducible description of infarction topographies; the results obtained lead us to recommend an echocardiographic standardization of ventricular segmentation and of nomenclature of infarction topographies, similar to that of pathological studies.