Left ventricular asynergy

Abstract

Left ventricular asynergy is a localized morphologic disturbance of ventricular wall motion which disrupts the normal coordinated pattern of left ventricular contraction. Several distinct types of asynergy are seen: akinesis, or local absence of wall motion; dyskinesis, or local expansile or paradoxical wall motion; asyneresis, or geometric distortion or inequality of wall motion; asynchrony, or a disturbed temporal sequence of contraction. These localized abnormalities are closely related to the anatomic, electrocardiographic, and biochemical zones of ischemia in coronary heart disease and are also seen in cardiomyopathy, rheumatic heart disease and other conditions that cause ventricular hypertrophy, and with ectopic excitation and activation of the left ventricle. Although often associated with clinical and, more frequently, laboratory evidence of cardiac failure, asynergy not uncommonly occurs in the absence of cardiac enlargement. Such morphologic abnormalities provide a functional basis for the hemodynamic disturbances seen in coronary heart disease. Thus, ventricular asynergy represents a dynamic abnormality appreciated only in life as a derangement of the integrated function of the left ventricle and represents an important cause of cardiac failure.