OBSERVATIONS OF THE RELATIONSHIP BETWEEN LEFT-VENTRICULAR ANEURYSM AND ST-SEGMENT ELEVATION IN PATIENTS WITH A FIRST ACUTE ANTERIOR Q-WAVE MYOCARDIAL-INFARCTION

Seventy-eight consecutive survivors of a first acute anterior Q wave myocardial infarction (AMI) underwent two-dimensional echocardiography (2D echo), colour Doppler echo and radionuclide angiography (RNA) for the diagnosis of left ventricular (LV) anteroapical aneurysm, in order to study the relationship of this complication to precordial ST segment elevation in these patients. The ST elevation (mm) in lead V-2, the maximum ST elevation in V-1-V-6 and the sum of ST elevation in V-1 to V-6 were calculated. LV aneurysm was present in 19 patients by 2D echo, of whom 12 had a paradoxical systolic flow pattern (red and outward towards the transducer) at the apex. There was no difference between the mean ST elevation in V-2 or rite maximum ST elevation in V-1-V-6 in patients with and without an aneurysm, although the sum of ST elevations in V-1 to V-6 was higher in the former group (P<0.01). ST elevation of patients with and without paradoxical systolic flow also did not differe significantly. Wall motion abnormality (akinesis and dyskinesis) by 2D echo in the anterior wall was seen in 74% of patients with and 36% of patients without an aneurysm (P<0.005), and in the septal region in 63% and 47% of respective patients (P-NS). There was no difference between the magnitude of ST elevation in subgroups of patients with ejection fraction (EF) less than or equal to 30% to greater than or equal to 40%, but the mean EF of patients with (23 +/- 2.1%) and without a LV aneurysm (34 +/- 1.3%) differed (P<0.001). It is concluded that precordial ST segment elevation does not clearly aid in the diagnosis of an anteroapical LV aneurysm. It is related to akinesis and dyskinesis in anterior and septal regions inherent in patients with AMI and does not indicate impaired LV function.