How does one differentiate between acute and chronic ischemia by 2DE?

This distinction is very difficult. Both acute and chronic ischemia can be characterized by hypokinesis and akinesis and severe left ventricular dysfunction.
1. In acute ischemia, the unaffected segments may reveal hyperkinesis as a compensatory mechanism (although in multivessel disease, the unaffected segment may not be hyperkinetic).
2. Secondary findings, such as thinned, hyperechoic myocardium and myocardial aneurysms, usually indicate old infarction.