The relationship between abnormal echocardiographic septal motion and myocardial perfusion in patients with significant obstruction of the left anterior descending artery.

Abstract

The relationship between segmental myocardial function and coronary perfusion in patients with high-grade stenosis of the left anterior descending artery was assessed. Patients (25) with critical lesions (> 70%) were divided into 2 groups according to the absence or presence of normal echocardiographic septal motion. Patients (12) had abnormal echocardiographic septal motion (AESM) and 13 patients had normal septal motion. Septal perfusion was evaluated by intracoronary injections of radiolabeled macroaggregated albumin (MAA) particles. Of the parameters analyzed abnormal septal perfusion was best related to AESM. Among the 12 patients with AESM, 10 had absent resting septal perfusion. Of the 13 patients with normal septal motion, 2 had abnormal septal perfusion. Septal width was significantly thinner in patients with AESM. When angiographic collateralization was associated with septal perfusion as detected by injection of MAA into the right coronary artery, normal septal motion was present (5 patients). When no septal perfusion resulted from right coronary injection, even though collaterals were seen angiographically, AESM was found (4 patients). In patients with severe left anterior descending stenosis the presence of abnormal echocardiographic septal motion strongly suggests absent septal perfusion and most likely infarction. Normal echocardiographic septal motion implies that resting septal perfusion is normal.