Comparison of shortening with timing of wall motion in detecting regional abnormalities of the left ventricle in coronary disease

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Abstract
Clinical observations suggest that ischemic myocardium may demonstrate delayed wall motion while absolute shortening remains normal. Wall motion timing and percent shortening were examined in 25 patients (7 normal, 18 coronary disease) with 35 mm biplane left ventriculograms and coronary arteriography. Mean age was 63 ± 2.4 years. Of 17 males and 8 females, 13 had 3 vessel, 4 had 2 vessel, and 1 had 1 vessel disease. Left ventricular regions were analyzed using the Coronary Artery Surgery Study nomenclature and quantitative computer‐based analysis as well as visual based qualitative analysis. Regional percent shortening and ejection fraction were calculated from end systolic and end diastolic frames. Regional shortening times were related to global ejection time from 30 frame/sec, frame by frame analysis. Feeder arteries were stenosed (>70%) in 135 of 225 left ventricular regions analyzed. Computer detection (shortening and timing) identified 97/225 as abnormal (P < 0.01 vs. feeder artery stenosis) while physicians identified 79/225 as abnormal (p < 0.01 vs. feeder artery stenosis). Of the 97 computer detected abnormal regions, shortening alone detected 47, timing alone detected 39, and 11 showed both abnormalities. Timing analysis increased detection of wall motion abnormalities from 58/225 (26%) to 97/225 (43%) (p < 0.001). Timing abnormalities were noted more (92%) in basal segments, while shortening abnormalities dominated (88%) in apical segments (p < 0.001). Use of temporal measurements in wall motion analysis significantly increases the likelihood of detecting abnormal left ventricular regional wall motion when compared to shortening measurements alone.