Regional contraction patterns in the normal and ischemic left ventricle in man

An angiographic method is introduced that permits detection and quantification of regional disorders of ventricular wall motion in man. The left ventricle is visualized as a muscular cone suspended freely from the atrioventricular ring. This ring, outlined partially by a coronary sinus catheter, serves as a fixed plane of reference for the motion of endocardial segments during systole. Regional motion of the left ventricle is analyzed by plotting the displacement of the apex and 6 hemiaxes during 4 sequential phases of systole. The nonischemic left ventricle (6 patients) revealed synchronous and symmetrical shortening of all segments. The middle and apical hemiaxes of the posterior wall shortened to a greater extent (62 and 70 percent, respectively) than the anterior wall segments (40 to 45 percent), and there was a slight angular displacement (5 °) of the apex toward the anterior wall. Of the ischemic hearts, 6 with predominant right coronary arterial lesions demonstrated posterior akinesis and dyskinesis during early systole and an exaggerated shortening, particularly in the posteroapical segment, during late systole. These findings were associated with a significant apical displacement (23 °) toward the wall opposite the ischemic zone. Six patients with major occlusive disease of the left anterior descending artery showed the same abnormal segmental pattern in an opposite direction. The study provides a simple technique for examining and quantitating localized disorders of wall motion, and the data indicate an association between the sites of major coronary occlusions and characteristic patterns of regional contraction.