title: [Initial phase of the left ventricular ejection (mesosystole) in coronary artery disease].
abstract: In patients with coronary artery disease (CAD), the ventricular ejection is altered specially the initial phase or the mid-systole. We studied such abnormalities through two-dimensional echocardiography and phonocardiography. We studied 40 patients with CAD and 11 normal subjects, we determined the times and volumes of total, initial and end of systole for to calculate the ejection fraction, integrated ejection and mean ejection rate. The measurements of total systole did not show important differences. In contrast, the initial ejection time (IET), the initial integrated ejection (IIE), the mid-systolic stroke volume (MSV), the mid-systolic ejection fraction (MEF) and the mean mid-systolic ejection rate (MMER) showed significant differences. The CAD group compared with normal subjects, had lower values of IET (P less than 0.05), MSV and MEF (P less than 0.01). The presence of myocardial infarction, the number of arteries with significant obstruction and the elevation of the left ventricular enddiastolic pressure had relationship with decrease in IIE (P less than 0.01) and with amount of MSV, MMER and MSV/end systolic stroke volume ratio (P less than 0.01). On the other hand, patients with angina, specially unstable and in those with ventricular aneurysm, the IIE showed higher values (P less than 0.01) and MSV, MMER, the percentage of mid-systolic ejection fraction and MSV/ESV ratio were lower (P less than 0.01). We conclude that in CAD, the mid-systolic changes are more sensitive than those of the whole systole. In presence of heart failure, the reduced stroke volume is ejected almost totally in the initial period or mid-systole. In patients with ventricular aneurysm or in those with unstable angina is the opposite behavior, the mid-systolic ejection is reduced and the small volume is ejected in the end last period or end systole. These observations could be useful to recognize the damage and the severity of it in CAD.
mesh_terms: D003327:Coronary Disease / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D010701:Phonocardiography; D013318:Stroke Volume; D013599:Systole
vernacular_title: La fase inicial de la expulsión del ventrículo izquierdo (mesosístole) en la enfermedad arterial coronaria.