The timing of paradoxical wall motion in ventricular aneurysms and in asynergic ventricles

The timing of paradoxical wall motion was investigated in the left ventricular cineangiograms of 15 patients in whom ventricular aneurysm was diagnosed or excluded at surgery. Eight had aneurysm and 7 had asynergic ventricles without aneurysm. Areas of paradoxical motion and inward motion were planimetered in each quarter of ejection. In both aneurysmal and asynergic ventricles paradoxical motion occurred within large akinetic areas. The extent of paradoxical motion was small, constituting only 3.4 and 2.6% of end-systolic areas. Over 80% of the maximal paradoxical motion occurred in the first half of ejection. In the latter half of ejection, further changes in paradoxical motion were small and inconsistent. There were no significant differences in the extent of quarterly paradoxical wall motion between the two patient groups. These data suggest that in the presence of marked left ventricular asynergy, the extent and timing of paradoxical wall motion from cineangiograms may not be useful in detection ventricular aneurysm.