Tardokinesis in coronary artery disease: evidence with instantaneous analysis of left ventricular ejection

Instantaneous measurements of ejection phase indices throughout the whole systole have been performed in 10 normal subjects (normal group), and in 8 coronary artery disease (CAD) patients (CAD group). All the patients of the CAD group were selected from 230 CAD patients because of their normal values in standard ejection phase indices (i.e. ejection fraction, EF; mean velocity of circumferential fiber shortening, VcfM; mean normalized systolic ejection rate, MNSER). An 'instantaneous' evaluation of the ventricular function, by means of a frame-by-frame analysis throughout the ejection period, allowed us to detect abnormalities of ventricular ejection in the early phase of systole in these CAD patients. In comparison with the control group, the CAD group presented similar peak values of dV/dt, dV/dt/EDV and Vcf, and a significantly longer time to peak values of these indices; EF curve analysis showed similar values at the end of systole in the two groups, but the mean curve of the CAD group was significantly lower in the first third of ejection when compared with that of control group. A segmental wall motion analysis in the early phase of systole showed a diffuse delayed ventricular wall motion (tardokinesis) related to abnormalities demonstrated by frame-by-frame analysis of ejection phase indices. Our results confirm that the CAD patients may have abnormalities of ventricular performance in the early phase of systole even when standard ejection phase indices are still within the normal range. In addition, the chronological appearance of these abnormalities during the whole systole has been clearly assessed; finally, these data confirm the importance of acceleration in blood ejection from the left ventricle as an index of ventricular function.