The study tested whether an experimental myocardial infarction can be detected from two-dimensional echocardiograms (2DE) by analysis of regional gray levels. The mid-left anterior descending coronary artery was ligated for 3 hours in 14 dogs (group 1) and for 5 hours in 6 dogs (group 2). 2DE were performed before, and after 3 and 5 hours of coronary artery ligation. The ultrasonic amplitude of the control and infarcted regions were obtained from digitized 2DE in the short axis view, at the mid-papillary muscle level. The mean gray levels (+/- SD) of the control and infarcted regions were compared during end-diastolic stop frames. After sacrifice, the hearts were cut into 1 cm thick slices and stained with 1% triphenyl tetrazolium chloride (TTC) solution. The myocardium was then studied by light microscopy. Computerized tomographic scans were also obtained in vitro from 3 hearts of both groups. There was no difference in mean gray levels of the control region during the experiments. However, in the region of wall motion abnormality (area of infarction), the mean gray levels increased from 49.9 +/- 3.5 (before ligation) to 62.0 +/- 7.4 (after 3 hours of ligation, p less than 0.005) in 10 group 1 dogs, but no differences were seen in mean gray levels (49.6 +/- 3.8 vs 50.4 +/- 4.0) in those without a myocardial infarction in 4 group 1 dogs; gray levels also increased from 50.4 +/- 2.9 (before ligation) to 58.6 +/- 6.1 (after 3 hours of ligation, p less than 0.05) and to 65.0 +/- 4.2 (after 5 hours of ligation, p less than 0.005) in group 2 dogs. The area of left ventricular asynergy corresponded precisely to the area of myocardial infarction, determined by both TTC staining and the computerized tomographic scans. The light microscopy of the infarcted area also demonstrated interstitial edema and polymorphonuclear cell infiltration.