Subtle left ventricular asynergy with completely obstructed coronary arteries

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Techniques

Background:

• Coronary artery disease (CAD) can present with seemingly normal left ventricular (LV) function on initial angiographic assessment.
• Subtle regional wall motion abnormalities may be missed by standard end-systolic analysis.

Purpose of the Study:

• To investigate the phenomenon of apparently normal LV wall motion in the presence of completely obstructed coronary arteries.
• To identify subtle asynergic areas using quantitative phasic biplane cineangiography in patients with CAD.

Main Methods:

• Quantitative phasic biplane cineangiography was performed on 16 patients with CAD and 18 control subjects.
• Angiographic contours were digitized, and 9 areas of motion were measured throughout ejection in both right and left anterior oblique planes.
• Normal LV motion values were established from the control group.

Main Results:

• Asynergic areas, undetectable by end-systolic analysis alone, were identified in 12 of 16 CAD patients.
• Phasic analysis of both planes revealed asynergy in 10 patients, with 18 of 19 asynergic areas correlating to high-grade CAD.
• All patients experienced angina pectoris; only 5 had prior infarction evidence.

Conclusions:

• Quantitative phasic biplane cineangiography is superior to standard end-systolic analysis for detecting subtle LV asynergies in CAD.
• Undetected wall motion abnormalities can occur despite apparently normal LV function in patients with significant coronary artery obstruction.
• This advanced imaging technique improves the detection of regional myocardial dysfunction in coronary artery disease.