Left Ventricular Electromechanical Mapping in Stunned Myocardium
A 62-year-old woman with a history of vasospastic angina presented to the emergency room with chest pain. The ECG showed ST-segment elevation in leads V3 through V6. The transthoracic echocardiogram revealed an akinetic left ventricular (LV) apical wall. The coronary angiogram on admission demonstrated normal coronary arteries.
Two weeks later, resting 99mTc-tetrofosmin myocardial single photon emission CT (SPECT) imaging revealed no perfusion defect (Figure 1⇓). The dobutamine stress echocardiogram showed that LV apical wall contractility increased from hypokinetic to hyperkinetic with a low dose of dobutamine. LV electromechanical mapping demonstrated normal unipolar voltage potentials (Figure 2⇓) and reduction of local endocardial shortening (Figure 3⇓) in the LV apical wall.
The LV electromechanical mapping procedure thus permitted online detection of stunned myocardium in the catheterization laboratory.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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