Disruption in the temporal sequence of regional ventricular contraction. I. Characteristics and incidence in coronary artery disease.
While spatial asynergy at end-systole has been well characterized in patients with coronary artery disease, assessment of regional asynchrony has been hampered by technical constraints. We developed a computer-assisted method for analyzing regional asynchrony from the equilibrium (ECG-gated) radionuclide ventriculogram. Twenty patients with normal contrast left ventriculograms (nine with a normal coronary arteriogram [group 1] and 11 with coronary artery disease [group 2]) and 20 patients with asynergy during contrast ventriculography (group 3) were studied. The earliest evidence of regional asynchrony occurred in early systole. Regional ejection fraction at one-third systole was 0.32 +/- 0.02 (mean +/- SEM) in group 1, 0.22 +/- 0.01 in group 2 (p less than 0.001) and 0.12 +/- 0.01 in asynergic regions in group 3 patients (p less than 0.001). In group 3, severe forms of regional asynchrony appeared in both early systole and early diastole: five patients (25%) had early systolic paradox, 13 (65%) had regional prolongation of peak ejection fraction and 16 (80%) had reduced percent peak ejection fraction at global end-systole. It appears, therefore, that there is progressively increasing regional asynchrony in patients with increasing severity of coronary artery disease.
D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003971:Diastole; D006329:Heart Conduction System / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D009200:Myocardial Contraction; D011877:Radionuclide Imaging; D013599:Systole; D013997:Time Factors