Left ventricular contraction in coronary heart disease

Abstract

Left ventricular contraction was studied in 128 patients with severely symptomatic coronary heart disease which was confirmed by coronary angiography. A classification of abnormal contraction is used based on left ventricular cine-angiography in the right anterior oblique projection. 1. Normal contraction (43 patients) 2. Local dyskinesis (47 patients) 3. General dyskinesis (17 patients) 4. Left ventricular aneurysm (21 patients) Patients with normal contraction usually had no history of infarction, no third or fourth heart sounds, no pathological Q waves, a normal chest radiograph, and normal haemodynamics. Ejection fraction mean 68.3%, s.d. 7.5. They had a random distribution of coronary arterial disease. Patients with local dyskinesis usually had a history of infarction, with evidence also seen in the electrocardiogram but rarely had abnormal praecordial movement, third or fourth heart sounds, left ventricular enlargement or pulmonary venous hypertension radiographically; the left ventricular end-diastolic pressure (post-‘a’) was often slightly raised, and coronary arterial disease mainly involved the left anterior descending and right arteries. The site of the dyskinesis corresponded to the vessel involved. Ejection fraction mean 45.2%, s.d. 13.3. Patients with general dyskinesis usually had a history of infarction, palpable left ventricular enlargement, third and fourth heart sounds, pathological Q waves on the electrocardiogram, left ventricular enlargement and pulmonary venous hypertension radiographically, a moderately raised left ventricular end-diastolic pressure, severe coronary arterial disease that involved all three vessels and reduced ejection fraction, mean 22.2%, s.d. 12.3. Patients with left ventricular aneurysm had a history of infarction, often without preceding angina pectoris, palpatory, electrocardiographic, and often radiographic evidence of an aneurysm, third and fourth heart sounds, pulmonary venous hypertension radiographically, a markedly left ventricular end-diastolic pressure, reduced ejection fraction, mean 27.1%, s.d. 14.5, and occlusion or severe narrowing of the left anterior descending artery, whilst the other vessels were comparatively free of disease. It is suggested that in this clinical group of patients with severely symptomatic coronary heart disease the distinction between localised dyskinesis and aneurysm as defined here is of practical value in surgical management.