Prognostic implications of regional hyperkinesia and remote asynergy of noninfarcted myocardium

To determine the clinical significance of regional hyperkinesia and remote asynergy of noninfarcted areas in patients with a first acute myocardial infarction (AMI), 2-dimensional echocardiography was performed in 113 consecutive patients within 12 hours after admission to the coronary care unit. In 98 patients (87%) all segments of the left ventricular wall were recorded. Infarct-associated asynergy was anterior in 63 and inferior in 35 patients. Regional hyperkinesia was present in 66 patients (67%)—44 of 63 with anterior (69%) and 22 of 35 with inferior (63%) infarcts—and was more frequently seen in patients with 1- and 2-vessel coronary artery disease (CAD) than in patients with 3-vessel CAD (87 and 72% vs 25%, p < 0.001). In contrast to enzymatic infarct size, absence of regional hyperkinesia was significantly associated with a higher left ventricular wall motion score (p < 0.01). Twenty patients died within 30 days after onset of AMI; in 15 (75%) regional hyperkinesia was absent. Absence of regional hyperkinesia, especially in anterior infarcts, was associated with a high mortality rate (13 of 19 patients [68%]). Remote asynergy, i.e., not adjacent to the infarct area and supposed to be related to another vascular region, was present in 17 of 98 patients (17%)—11 of 63 with anterior (17%) and 6 of 35 with inferior (17%) infarcts. Remote asynergy was present only in patients with multivessel CAD and was significantly related to a higher wall motion score (p < 0.001), but not to enzymatic infarct size. Also, the presence of remote asynergy was associated with a high mortality rate (9 of 17 patients [53%]). Thus, regional hyperkinesia and remote asynergy of the noninfarcted areas in patients with a first AMI provide useful information about the extent of CAD and may identify patients at high risk for early (within 30 days) mortality.