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Subtle left ventricular asynergy with completely obstructed coronary arteries
Insights
Quantitative analysis revealed subtle left ventricular wall motion abnormalities in patients with coronary artery disease (CAD), even when initial assessments appeared normal. This highlights the importance of detailed analysis for accurate diagnosis of CAD.
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.
Abstract:
The phenomenon of apparently normal angiographic left ventricular wall motion in the presence of greater than or equal to 1 completely obstructed coronary artery was investigated in 16 patients with coronary artery disease (CAD) by quantitative phasic biplane cineangiography. Angiographic contours were digitized at quarterly intervals throughout ejection and 9 areas of motion were measured in both right and left anterior oblique planes. Normal values were derived from 18 other patients who had normal coronary arteries and normal left ventricular function. Areas of asynergy undetected when quantitative analysis was applied only at end-systole in the right anterior oblique plane were found in 12 of the 16 patients with CAD: in 2 patients by end-systolic analysis in the left anterior oblique plane and in 10 patients by phasic analysis of both planes. Of 19 asynergic areas 18 corresponded to sites of high-grade CAD. All patients had angina pectoris, but only 5 had clinical or electrocardiographic evidence of prior infarction.