Evaluation of Asynergy As an Indicator of Myocardial Fibrosis

SUMMARYThe presence and location of asynergy within the ventriculograms of 24 patients were compared with the quantity and site of fibrosis found in the left ventricle during postmortem examination. Asynergy was detected both qualitatively, by visual inspection, and quantitatively, by tracing end-systolic and end-diastolic outlines of the left ventricle with a sonic digitizer-computer system. The perimeters of fibrotic areas were traced during postmortem study with a sonic digitizer from photos of heart slices.For the RAO view, the qualitative and quantitative methods in the 24 hearts agreed on the presence or absence of asynergy in 58 of 72 (82%) of the anterior, posterior, and apical walls. In 12 of 14 (86%) walls in which the two methods disagreed, the presence or absence of quantitatively, but not qualitatively, determined asynergy correctly indicated the presence or absence of fibrosis within the wall. Of the 44 walls containing fibrosis, 35 (76%) demonstrated asynergy qualitatively while 42 (95%) exhibited asynergy quantitatively. Mean fibrosis increased with increasing severity of quantitatively determined asynergy: normal wall motion, 0.4% fibrosis; hypokinesis, 6.3%; akinesis, 14.3%; and dyskinesis, 30.1%. For the LAO view, neither qualitatively nor quantitatively determined asynergy in the lateral and septal walls was as closely related to fibrosis as In the RAO view. The ejection fraction was linearly correlated with the percent fibrosis of the entire left ventricle (r = -0.88).This study provides evidence that quantitatively determined asynergy in the RAO ventriculogram can serve as an indicator of fibrosis within the left ventricle.