Open AccessDiverging effects of postextrasystolic potentiation on left ventricular segmental wall motion in coronary heart disease
Author(s) -
Di Donato M.,
Barletta G. A.,
Maioli M.,
Fantini F.
Publication year - 1987
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960101013
Subject(s) - medicine , cardiology , coronary artery disease , basal (medicine) , ejection fraction , angina , myocardial infarction , infarction , heart failure , insulin
The effects of postextrasystolic potentiation (PESP) on regional left ventricular (LV) wall motion were evaluated in 40 coronary artery disease (CAD) patients. Of the 40 CAD patients, 20 had a prior myocardial infarction and 20 had a history of angina pectoris. PESP was obtained by applying programmed atrial stimulation during LV angiography, in a way that basal cycle length, premature beat, and postextrasystolic pause were almost identical in all patients. Segmental wall motion was evaluated by calculating regional ejection fraction (EF) of 5 different areas with a computerized method before and after the premature beat. The results were compared to those obtained in a group of 8 normal subjects. LV areas were classified as normokinetic, mildly hypokinetic, severely hypokinetic, and hyperkinetic, on the basis of their regional EF in respect to normals, and classified as “responder” (R) and “nonresponder” on the basis of the magnitude of the increase of regional EF with PESP. Of a total of 200 areas 129 were normokinetic (68% R), 45 were mildly hypokinetic (78% R), 17 severely hypokinetic (76% R), and 9 were hyperkinetic (78% R). Infarcted patients had a higher percentage of hypokinetic areas in basal conditions (p<0.001), however, the percentage of hypokinetic areas that responded to PESP was not significantly different from noninfarcted patients. In CAD patients, as a whole, a significant direct correlation was found between basal regional EF and regional EF after PESP (r=0.88, p<0.01). In conclusion, the results indicate: (1) normokinetic LV areas do not always respond to PESP; (2) while infarcted patients have a higher proportion of myocardial segments that are hypokinetic, the number of these areas that respond to PESP does not differ between infarcted and noninfarcted patients; (3) in CAD patients there is a direct relationship between the degree of basal regional function and the magnitude of the response to PESP.