Wall motion abnormalities

Echocardiogram Used to assess LV size, valve function, pericardial effusion, wall motion abnormalities, and ejection fraction. 

Wall motion abnormalities or left ventricular dilation with stress echocardiography are indicative of IHD. 

Radionuclide angiocardiography is used to measure ejection fraction (EF), regional ventricular performance, cardiac output, ventricular volumes, valvular regurgitation, asynchrony or wall motion abnormalities, and intracardiac shunts. 

A transthoracic echocardiogram can detect valve or wall motion abnormalities that are sources of emboli to the brain. 

Tillisch J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps M et al. Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. N Engl J Med 1986 314 884-888... 

Hypokinetic heart wall motion abnormalities and early signs of chronic cardiomyopathy have been identified as a significant toxic effect of mitoxantrone in patients who received cumulative doses of 32-174 mg (31). Electrocardiographic T wave inversion and cardiac complications have been described from intensive therapy with mitoxantrone 40 mg/m over 5 days and cyclophosphamide 1550 mg/m for 4 days, given before bone marrow transplantation for metastatic breast cancer. All the patients had had previous exposure to doxorubicin in cumulative doses that did not exceed 442 mg/m (19). 

Cohen M, Scharpf SJ, Rentrop KP. Prospective analysis of electrocardiographic variables as markers for extent and location of acute wall motion abnormalities observed during coronary angioplasty in human subjects. J Am Coll Cardiol 1987 10 17. 

Mahrholdt H, Zhydkov A, Hager S et al. Left ventricular wall motion abnormalities as well as reduced wall thickness can cause false positive results of routine SPECT perfusion imaging for detection of myocardial infarction. Eur Heart J 2005b 26 2127. 

ECHO remains the procedure of choice in the diagnosis and evaluation of a number of conditions such as valvular dysfunction (aortic and mitral stenosis and regurgitation and endocarditis), wall motion abnormalities associated with ischemia, and congenital abnormalities, such as ventricular or atrial septal defects. Images obtained from ECHO are used to estimate chamber wall thickness and left ventricle ejection fraction, assess ventricular function, and detect abnormalities of the pericardium such as effusions or thickening. 

Dobutamine, a synthetic catecholamine, increases heart rate and cardiac output, resulting in an increase in myocardial oxygen demand. Ischemia develops in areas where stenosis prevents the increase in oxygen demand from being met with increased blood flow. Ischemia is detected by ECHO as regional wall motion abnormalities or with thallium scanning. 

Paradoxical splitting of S2 Left ventricular wall motion abnormality Very uncommon but occasionally noted during angina... 

Patients with anterior myocardial wall motion abnormalities or LV thrombus. 

Warfarin should be considered in selected patients following an ACS, including patients with a left ventricular thrombus, patients demonstrating extensive ventricular wall motion abnormalities on cardiac echocardiogram, and patients with a history of thromboembolic disease or chronic atrial fibrillation. A more detailed discussion regarding the use of warfarin is available in Chap. 19. 

A transthoracic echocardiogram (TTE) will determine whether valve abnormalities or wall motion abnormalities are sources of emboli to the brain. A "bubble test" can be done to look for an intraatrial shunt indicating an atrial septal defect or a patent foramen ovale. 

As previously discussed, ejection fraction remains the most important prognostic marker, and echocardiography is perhaps the most widely used tool for its assessment. In addition to this finding, however, echocardiography can also assess the functional importance of coronary lesions by evaluating for inducible regional wall motion abnormalities or even global left ventricular dysfunction. 

Arai K, Hozumi T, Matsumura Y, Sugioka K et al (2004) Accuracy of measurement of left ventricular volume and ejection fraction by new real-time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction. Am J Cardiol 94 552-558... 

Fig. 15.5. Retrospectively gated image acquisition by CT does not only contain information about the coronary arteries but also about the function of the myocardium. Newer postprocessing is under development, and tries to determine the axial CT slices reconstructed at different time points of the cardiac cycle. These workstations may provide data about the global functional parameter, as well as regional wall motion abnormalities...

Fig. 21.5. Coronary CTA data sets of two different patients with apical clot formation (arrows) due to wall motion abnormalities after myocardial infarction...

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