Distribution and severity of left ventricular wall motion abnormalities according to age and coronary arterial pattern in 500 patients with coronary artery disease and angina pectoris

Abstract Left ventriculograms of 500 patients with coronary artery disease and angina pectoris were compared with respect to coronary arterial pattern, left ventricular dyssynergy, and the patient's age. The coronary arterial patterns were separated into Right, Mixed, and Left systems depending upon the blood supply to the inferior surface of the left ventricle. The left ventriculograms were divided into two regions and five areas. The anterior region consisted of the anterobasal area, anterolateral area, and the apical area. The posterior region consisted of the diaphragmatic area and the posterobasal area. Areas were scored as normal, hypokinetic, akinetic, or dyskinetic. The following relationships were noted: 1. 1. Forty percent of patients with coronary artery disease and angina pectoris have normal left ventricular wall motion. In the 60% of patients with left ventricular dyssynergy, wall motion abnormalities are divided evenly into three categories: anterior dyssynergy alone, posterior dyssynergy alone, and combined anterior and posterior dyssynergy. The mean age of patients with normal and dyssynergic wall motion is strikingly similar. 2. 2. Coronary arterial patterns of Right, Mixed, and Left systems have little, if any, influence on left ventricular wall motion abnormalities. 3. 3. Hypokinesis is the most common wall motion abnormality found in patients with coronary artery disease regardless of coronary arterial distribution or region of the left ventricle affected, with the exception of the apical area, where dyskinesis is found most commonly. Dyssynergy occurs most commonly in adjacent areas. In the anterior wall dyssynergy, the anterolateral and apical areas of the left ventricle are involved together most commonly. In posterior wall dyssynergy, the diaphragmatic and posterobasal areas of the left ventricle are involved most commonly. 4. 4. In patients with coronary artery disease and angina pectoris, left ventricular dyssynergy is similar from the third to the eighth decade of life.