Function of Left Ventricle and Extent of Coronary Arterial Lesions: Failure of Correlation in Cineangiographic Studies

¹ Department of Medicine, State University of New York at Buffalo and the Buffalo General Hospital, Buffalo, New York

In patients with technically adequate selective coronary arteriograms and left ventriculograms, a scoring system was used to grade the severity of coronary obstruction from 0 (no disease) to 15 (total obstruction of all three major coronary arteries). The median score in 75 consecutive cases was 10. Three hemodynamic measurements were examined in these patients; left ventricular end-diastolic pressure (EDP), end-diastolic volume (EDV) and residual fraction. Left ventricular volume estimates were derived from one-plane cineangiograms in the right anterior oblique view. These hemodynamic parameters (EDP, EDV and residual fraction) did not correlate significantly with the severity of coronary disease. However, in eight patients who had clinical evidence of congestive failure, all had abnormal value of EDP, EDV, and residual fraction. These same measurements were also abnormal in three patients without clinical evidence of failure; a fourth patient had an increase in residual fraction without other abnormality; this group of four patients have myocardial impairment without the congestive failure syndrome. All 12 patients with an increased residual fraction had akinesis or dyskinesis of the ventricular wall. As expected, EDV correlated well with residual fraction (r = 0.72) and worse with EDP (r = 0.44).