EchoCG has a lower diagnostic value than an ECG in the diagnosis of various forms of coronary heart disease. At the same time, with the help of this method it is possible to reveal a number of signs indirectly indicating a possible violation of coronary blood flow. In the one-dimensional and two-dimensional modes, this is the detection of zones of hypo-akinesis or dyskinesias in the zones corresponding to the blood supply basin of the corresponding coronary artery with the presence of compensatory hyperkinesis in the opposite part of the LV , identification of areas of fibrosis and myocardial thinning (especially in the presence of LV aneurysms), signs of structural LV remodeling with the development of a picture of ischemic cardiomyopathy (ICMP) (usually characterized by an increase in the LV cavity, mainly due to a course of systolic size, moderate hypertrophy of its walls, signs of systoleus – Dias tolic dysfunction) . In a number of patients with ICMP, near-wall thrombi can be found in the LV cavity . The use of stress echocardiography (most often with dobutamide) allows a number of patients to identify areas of hibernated (“sleeping”) myocardium (increased excursion in the affected area against dobutamide), which allows us to select patients for cardiac surgery.

The paradoxical movement of MLS in a patient with acute myocardial infarction .

A picture of ICMP in a patient with postinfarction cardiosclerosis (fibrosis, thinning and paradoxical movement of the IUS; hyperkinesis of the LV LV wall; dilatation of the LV; reduction of LV LV).


According to some authors, heart changes in arterial hypertension (AH) are found only in 55 – 65% of patients. Moreover, the development of structural changes and their degree do not depend on the duration of the disease, nor on the degree of increase in blood pressure, but mainly reflect the individual (genetically determined) heart response to hemodynamic load. Structural changes in the LV (its remodeling) with hypertension are associated either with an increase in the LV cavity, or with a thickening of its walls, or affect both of these indicators. In all these cases, an increase in the LV myocardium mass is observed. – LV hypertrophy (LVH) (myocardial mass index is more than 150 g / m 2 for men and 120 g / m 2 for women). To identify the nature of LV remodeling, two main criteria are used:

1. the indicator of the relative thickness of the myocardium (OTM); OTM = (TMZHP + TZSLZH) / KDR,

where, TMZHP – thickness of the interventricular septum, TZSLZH – thickness of the posterior wall of the left ventricle, CDR – end-diastolic size of the left ventricle;

2. iKDR – end-diastolic size index (KDR / body area).

In accordance with these criteria, the following are distinguished: eccentric (dilatation) remodeling (iKDR more than 3.2 cm / m 2 , OTM less than 0.45); concentric remodeling (iKDR less than 3.2 cm / m 2 , OTM more than 0.45) and mixed remodeling.

In all these forms, the LVH often reveals violations of the LV diastolic function (with a concentric – rigid type, with an eccentric – restrictive). The LV pumping function is most often impaired with an eccentric remodeling option. It should be noted that in addition to the three main variants of LVH, there are more rare transitional forms (hypertrophy of the outgoing branch of the IUP, isolated hypertrophy of the IUR, etc.)

Leave a Reply

Your email address will not be published. Required fields are marked *