Correction of left ventricular asynchrony by coronary artery surgery

To investigate the effect of coronary artery bypass grafting on the timing of regional left ventricular wall motion, contrast left ventriculograms from 27 patients were digitised frame by frame before and after operation. End diastolic and end systolic volumes, ejection fraction, and peak ejection and filling rates showed no significant change. The commonest preoperative abnormality was delayed onset of inward wall motion during ejection, which was present in 14 patients over 10% (range 5-40%) of the cavity outline, leading to a pattern of "diagonal contours". After operation this pattern had resolved completely in 12 patients and partially in two. Minor abnormalities appeared postoperatively in five but overall the mean (1SD) area affected was reduced by 5 (8)%. The time span between the onset of inward motion in different regions of the cavity also fell significantly after surgery from 190 (50) to 130 (50) ms. Regional hypokinesis (6 cases) and abnormal wall motion during isovolumic contraction (4 cases) or isovolumic relaxation (5 cases) were not consistently affected. Thus successful coronary artery surgery is without consistent effect on overall left ventricular function, overall hypokinesis, or abnormal wall motion during the isovolumic periods. It does, however, strikingly reduce the asynchrony of wall motion during ejection, suggesting that before operation this abnormality may directly reflect impaired coronary blood flow. The results emphasise the potential value of analysing regional wall motion to elucidate functional abnormalities associated with coronary artery disease.