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Abnormal left ventricular wall movement in patients with chest pain and normal coronary arteriograms. Relation to
Insights
Regional wall motion abnormalities in patients with angina and normal coronary arteries suggest delayed contraction onset. This may cause localized ischemia, particularly during tachycardia.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Patients with angina and normal coronary arteries present a diagnostic challenge.
- Understanding regional myocardial function is crucial for diagnosing cardiac ischemia.
Purpose of the Study:
- To investigate regional abnormalities of left ventricular wall motion in patients with angina and normal coronary arteriograms.
- To correlate these abnormalities with clinical and electrocardiographic findings.
Main Methods:
- Digitization of left ventriculograms from 45 patients with angina and normal coronary arteriograms.
- Frame-by-frame analysis to detect regional wall motion abnormalities during systole and diastole.
Main Results:
- 10 patients showed regional outward movement during early systole; 10 showed abnormal inward movement during isovolumic relaxation.
- Affected segments had normal ejection amplitude and peak velocity.
- These disturbances correlated with inferior T wave changes and mitral valve prolapse.
Conclusions:
- Delayed onset of contraction in affected myocardial segments is proposed.
- This may lead to localized ischemia due to impaired coronary flow, especially during tachycardia.
Abstract:
Left ventriculograms of 45 patients with angina and normal coronary arteriograms were digitised frame by frame in order to detect regional abnormalities of wall movement. Though left ventricular pressures, end-diastolic volume, and ejection fraction were normal in all, regional outward movement during early systole was present in 10 patients, and abnormal inward wall movement during isovolumic relaxation also in 10, involving the apex or inferior surface. Both were present together in 8 patients, and affected segments showed normal amplitude and peak velocity of movement during ejection. These disturbances of wall movement were associated with inferior T wave changes on the electrocardiogram, and mitral prolapse, particularly when the latter resulted from delayed movement of the valve during ejection. It is suggested that the onset of contraction is delayed in affected areas, but that it proceeds normally thereafter. The resulting persistence of tension into the period of relaxation of the remainder of the ventricle may interfere locally with coronary flow, particularly during tachycardia, thus causing manifestations of regional ischaemia.