Comparative evaluation of segmental asynergy in remote myocardial infarction by radionuclide angiography, two-dimensional echocardiography, and contrast ventriculography.

Radionuclide angiography (RNA), two-dimensional echocardiography (2DE), and contrast ventriculography (CVG) were compared in the evaluation of regional wall motion (RWM) in 58 patients with remote myocardial infarction (MI). All 58 patients were studied by 2DE, 52 by RNA, and 24 by CVG. Severe degrees of segmental asynergy (akinesia/dyskinesia) were noted more often by 2DE (56% of all segments, p less than 0.005) and CVG (52%, p less than 0.05) than by RNA (39%). The apex more the most frequent site of akinesia/dyskinesia by all technique (43% by RNA, 36% by 2DE, and 45% by CVG). 2DE and RNA agreed in 64% of regions (p less than 0.005), 2DE and CVG agreed in 68% (p less than 0.005), and RNA and CVG agreed in 70% (p less than 0.005); the highest agreement was for the apical region. Dyskinesia was noted in 77% of patients by RNA, in 71% by 2DE, and 79% by CVG. RNA and CVG agreed in 89% of patients and in 57% of regions, 2DE and CVG agreed in 67% of patients and in 53% of regions, and RNA and 2DE agreed in 71% of patients and in 38% of regions. Combined RNA and 2DE detected dyskinesia in 94% of the 16 patients with dyskinesia by CVG who underwent all three techniques and in 90% of the 52 patients studied by RNA and 2DE. We conclude that (1) RNA, 2DE an CVG agree significantly in the evaluation of regional wall motion; (2) there is better agreement concerning the presence or absence of dyskinesia in a given patients than the exact region involved; and (3) the combination of RNA and 2DE is more useful than either alone as a screening procedure for the detection of ventricular dyskinesia.