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While spatial asynergy at end-systole has been well characterized in patients with coronary artery disease, assessment of regional asynchrony has been hampered by technical constraints. We developed a computer-assisted method for analyzing regional asynchrony from the equilibrium (ECG-gated) radionuclide ventriculogram. Twenty patients with normal contrast left ventriculograms (nine with a normal coronary arteriogram [group 1] and 11 with coronary artery disease [group 2]) and 20 patients with asynergy during contrast ventriculography (group 3) were studied. The earliest evidence of regional asynchrony occurred in early systole. Regional ejection fraction at one-third systole was 0.32 +/- 0.02 (mean +/- SEM) in group 1, 0.22 +/- 0.01 in group 2 (p less than 0.001) and 0.12 +/- 0.01 in asynergic regions in group 3 patients (p less than 0.001). In group 3, severe forms of regional asynchrony appeared in both early systole and early diastole: five patients (25%) had early systolic paradox, 13 (65%) had regional prolongation of peak ejection fraction and 16 (80%) had reduced percent peak ejection fraction at global end-systole. It appears, therefore, that there is progressively increasing regional asynchrony in patients with increasing severity of coronary artery disease.

Disruption in the temporal sequence of regional ventricular contraction. I. Characteristics and incidence in coronary artery disease.