In order to assess the value of two-dimensional echocardiography in the detection of abnormal left ventricular wall motion, 56 consecutive patients were prospectively studied less than 24 hours before left ventricular angiography, performed to evaluate the presence and extent of coronary arterial disease. The two-dimensional echocardiography studies were independently recorded by two observers (RT and MB) without previous knowledge of the patients' clinical, electrocardiographic, and

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... l data. Wall motion was classified as normal, hypokinetic, dyskinetic, and aneurysmal. Angiography was reported by an independent observer (SR) without knowledge of other data. In 50 of the 56 patients the two-dimensional echocardiography study was suitable for analysis. Of these 50 patients, in 23 the left ventricular angiograms were normal: in one of these, two-dimensional echocardiography was considered to be abnormal. Of the 27 patients with abnormal left ventricular angiograms, two-dimensional echocardiograms were interpreted as abnormal in 20 and in 18 of these, the sites of abnormal contraction corresponded with those seen on the angiogram. Errors in interpretation of the two-dimensional echocardiograms were the result of the use of a narrow angle transducer and of inadequate visualisation of the left ventricular endocardium as well as of small areas of dyskinesis. Two-dimensional echocardiography is a reliable non-invasive method to exclude abnormalities of left ventricular wall motion. The presence and site of abnormal wall motion can be detected by twodimensional echocardiography and corresponds to the findings of left ventricular angiography in the majority of patients. Cross-sectional echocardiography in the early detection of acute myocardial ischaemia and infarction London Fifty patients with suspected diagnosis of acute myocardial infarction had cross-sectional echocardiographic studies on admission and 48 hours later. None had a past history of myocardial infarction. The left ventricular wall was divided into 11 segments, and segmental wall motion defined and scored as normal (0), hypokinetic (1), akinetic (2), or dyskinetic (3). The degree of asynergy calculated was expressed as a percentage (normal 0%, total dysnergy 100%) and compared with creatine kinase level and 12 lead electrocardiogram. Myocardial infarction was later confirmed in 40 patients. Raised percentage asynergy was present in 39 on admission and in the remaining one at 48 hours. The diagnosis could not be confirmed in 17 of these on admission-eight patients had normal creatine kinase and nine patients had non-diagnostic electrocardiograms. All showed left ventricular wall motion abnormality on admission (% asynergy score 33). Two patients whose electrocardiograms showed acute ischaemic patterns had left ventricular asynergy (% score 15) on admission-the echocardiograms reverted to normal after the acute ischaemic episode. These findings indicate that cross-sectional echocardiography is a sensitive method of early detection of acute myocardial ischaemia and infarction. It is of particular value when initial creatine kinase and electrocardiogram are not diagnostic. 510 on 19 July 2018 by guest. Protected by copyright.