Subtle left ventricular asynergy with completely obstructed coronary arteries

The phenomenon of apparently normal angiographic left ventricular wall motion in the presence of ≥ 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.