Abnormal left ventricular wall movement during early systole in patients with angina pectoris.

Left ventricular cineangiograms of 105 patients with chest pain were digitised frame by frame and local endocardial movement displayed in order to study events during isovolumic contraction. Of these patients, 90 had coronary artery disease and the remainder were considered normal. In normal subjects, there was a 6 per cent reduction in cavity area before the onset of aortic valve opening, caused by inward movement of endocardium on the upper part of the anterior wall, so that the cavity became less circular. In 34 patients with coronary artery disease, abnormalities of isovolumic contraction were present. These consisted of: (1) segmental outward movement of 2 mm or more (mean 4 ± 2 mm) in 23, and (2) premature inward movement along the inferior wall in a further 11. Of the former 23 patients, overall amplitude of wall movement during ejection was greater than 60 per cent than in control regions of the same ventricle in 14 (type I), and less in 9 (type II), because of local disease. These abnormalities of isovolumic contraction were unrelated to the distribution of coronary artery lesions, but were more frequent in the presence of anterior Q waves. Type I abnormalities also occurred in 3 additional patients with normal coronary arteriograms. All but 2 of the patients with type I abnormalities had additional disturbances of endocardial movement during isovolumic relaxation, affecting the same region of ventricle. Disturbances of endocardial movement during isovolumic contraction are thus relatively common in patients with angina pectoris, and may cause significant interference with left ventricular function.