What does anterior hypokinesis mean
74 year old patient with the following medical history:
- Type 2 diabetes mellitus
- bronchial asthma
Video 1 shows a functional analysis at rest. The left ventricle appears hypertrophied (septum thickness: 16 mm), but is of normal size (end-diastolic diameter: 48 mm) and shows a normal ejection fraction (EF = 63%). There are no wall movement disorders at rest. The aortic valve opens and closes unobtrusively.
Video 2 shows the short axis geometry in the basal, medial and apical planes at rest. There are no wall movement disorders. In the so-called "bulls eye" the 17 left ventricular segments are shown according to the classification of the American Heart Association and allow a visual description of the wall movement in each individual segment. In the current case there is normokinesia in every single segment. The dobutamine infusion is initiated and increased as described. At a dose of 20 µg / kg / min and a heart rate of 129 / minute (88% of the maximum heart rate), the patient reports typical angina pectoris.
Video 3 shows the basal, medial and apical short axis view at a dose of 20 µg / kg / min dobutamine together with the visual representation of the wall movement per segment (bulls eye). Here, stress-induced, newly occurring wall movement disorders can be documented, showing hypokinesia in segment 5 (basal inferolateral) and segment 13 (anterior apical). Figure 3 shows the exact location of the stress-induced wall movement disorders (red arrows).
In the perfusion under dobutamine (video 4), a perfusion defect is seen in segment 5 (basal inferolateral) and segment 13 (anterior apical). The location of the stress-induced perfusion defect is congruent with the segments in which a stress-induced wall movement disorder occurred. Figure 4 shows the exact location of the perfusion defects (red arrows).
Video 5 shows the perfusion at rest, perfusion defects do not occur at rest.
Although a resting perfusion is not always carried out, in the case described there is a clear distinction between the findings during exercise and at rest. This enables ischemia-related perfusion defects to be distinguished from artifacts. Figure 5 compares a stress and rest perfusion examination:
The areas marked by the red arrows show typical perfusion defects that only occur under stress. The hypointense areas, which are marked by the green arrows, occur during rest and exertion examinations and represent typical "dark rim artifacts (see also chapter on perfusion).
Figure 6 demonstrates the patient's late gadolinium enhancement images. A contrast agent enrichment and thus evidence of fibrosis / myocardial scars is not present in this patient.
In summary, stress-inducible wall movement disorders as well as perfusion defects in segment 5 (basal inferolateral) and segment 13 (apical anterior) can be documented in the patient described. The function of the left ventricle at rest is normal / normal; significant myocardial scars can be excluded. Based on the findings obtained, there is a high degree of suspicion of CHD in this patient.
An invasive cardiological diagnosis was carried out. This showed a 25-50% reduction in diameter of the left main trunk (B), a 75% lesion in the area of the proximal and medial LAD (AD) and a 90% stenosis in the area of the RCX (A, B), Figure 7. In addition, there were 75% stenoses in the area of the RCA. Surgical therapy was recommended.
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