Left ventricular anatomical and functional abnormalities in chronic postinfarction heart failure.

Abstract

Fifty patients with chronic postmyocardial infarction heart failure had quantitative biplane angiocardiography; 42 also had coronary angiography. Mitral regurgitation, localized ventricular contraction abnormality, increased end-diastolic volume, low ejection fraction, low cardiac index, and high left ventricular end-diastolic pressure occurred in various combinations. Mitral regurgitation averaged 2.11 liter/min per m2 body surface area and occurred most commonly with right coronary occlusion, low cardiac index or elevated left ventricular end-diastolic pressure or both, and left ventricular end-diastolic volumes exceeding 155 ml/m2 body surface area. End-diastolic volumes were increased in 86% and ranged to 450 ml/m2 body surface area. Ejection fractions were below 0.50 in 92%. Coronary angiographic findings correlated poorly with ventricular hemodynamic values. Localized contraction abnormalities included aneurysms with up to 40 ml per stroke paradoxical blood flow. Localized contraction abnormalities were not significantly more frequent in patients with low cardiac indexes or elevated left ventricular end-diastolic pressure, or both. High ventricular filling pressure or a low cardiac index, or both, was not commoner with multiple than with single vessel disease.