[Two-dimensional echocardiographic approach to the localization of myocardial infarction: echocardiographic, electrocardiographic, and coronary arteriographic correlations (author's transl)].

Location of infarct lesions (IL) demonstrated by two-dimensional echocardiography (2DE) was correlated with electrocardiographic patterns of myocardial infarction and with the sites of obstructive lesions in the individual coronary arteries. The left ventricular wall was displayed by phased-array 2DE in 47 patients with healed myocardial infarction, 29 of whom underwent coronary arteriography. Segmental analysis of IL was performed on 14 segments, 10 of which were obtained by the parasternal short-axis recordings at the mitral (basal) and papillary muscle (mid) levels (each level containing the anterior septum, anterior wall, lateral wall, posterior wall, and posterior septum). The remaining 4 segments (septum, anterior wall, lateral wall, posterior wall) were obtained by the apical 2-chamber and 4-chamber recordings. IL were defined as akinesis, thinning, increased echo density, or absent systolic thickening of the left ventricular wall. All 22 patients with anterior infarction (Q in V1-V4) had IL in the mid anterior septum which was specific for the lesion of the left anterior descending artery (LAD). The presence or absence of the r wave in V1 could not predict the involvement of this segment. IL in the apical anterior wall and septum were observed in 21 of 22 patients. The presence of Q waves in V5, V6 suggested the additional involvement of the apical posterior wall. Additional Q waves in I, aVL indicated the extension of IL from the mild anterior septum to the basal anterior septum, anterior wall, and mid anterior wall. The basal and mid lateral walls appeared normal in most patients. This pattern of IL distribution was observed in 5 of 6 patients with a stenosis on the proximal LAD. All 14 patients with inferior infarction (Q in II, III, aVF) had IL in the mid posterior wall and posterior septum. In contrast, 5 patients with infero-posterior infarction (Q in II, III, aVF + R in V1) and 6 patients with posterior infarction (R in V1) had IL in the mid lateral as well as the mid posterior wall without an involvement of the posterior septum. Coronary arteriography revealed that all of the 10 patients with inferior infarction had a stenosis in the right coronary artery, whereas 6 patients with infero-posterior or posterior infarction invariably had a stenosis in the left circumflex coronary artery. It was concluded that 2DE provides a reliable method for detecting IL and anatomic location of myocardial infarction reflecting a specific coronary artery disease.