ASYNCHRONOUS LEFT-VENTRICULAR WALL-MOTION IN UNSTABLE ANGINA

The objective of the study was to assess the nature of left ventricula r wall motion disturbances in patients with unstable angina and the re lative contributions of the severity of symptoms and the severity of c oronary artery disease (CAD) to their genesis. A prospective examinati on was performed on 30 patients with unstable angina (UA) with triple CAD, 34 matched patients with chronic stable angina (CSA) (20 with tri ple CAD and 14 with isolated left anterior descending (LAD) artery dis ease), and compared to 21 normals. LV cavity size was normal in all th ree groups. Twenty-two of 30 patients with UA had marked (>3 mm) abnor mal long axis shortening during isovolumic relaxation time (IVRT), 65% of LV sites being abnormal. In CSA, minor (<3 mm) shortening during I VRT occurred in 7 patients with triple CAD, and in 5 with LAD disease, with 12% of LV sites involved in both groups, P<0.001 vs. UA. The inc idence of other long axis abnormalities, including reduced extent and peak rate of shortening and lengthening as well as the delay in the on set of shortening and lengthening was increased between patients with CSA and triple CAD compared with LAD but not between the two groups of patients with triple CAD, CSA and UA. Transmitral E/A ratio was also reduced in the two groups with triple vessel disease, CSA and UA. Thus , the incidence of minor long axis abnormalities is similar in CSA and UA and is related to the severity of CAD. However, abnormal shortenin g during IVRT is more severe and generalised in UA but not in CSA with triple vessel disease. We suggest that these abnormalities of wall mo tion bear a close relation to the development of instability within th e setting of CAD. (C) 1997 Elsevier Science Ireland Ltd.