Late Systolic Bulging of Left Ventricle in Patients with Angina Pectoris

A Form of Asynchronous Contraction

¹ Department of Medicine, Cardiology Division and Department of Surgery, Cardiovascular Division, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York; Queens Hospital Center Affiliation, Jamaica, New York; School of Medicine, Health Sciences Center, State University of New York at Stony Brook, New York
² Department of Medicine, Cardiology Division and Department of Surgery, Cardiovascular Division, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York, Queens Hospital Center Affiliation, Jamaica, New York and the School of Medicine, Health Sciences Center, State University of New York at Stony Brook, New York
³ Department of Medicine, Cardiology Division and Department of Surgery, Cardiovascular Division, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York; Queens Hospital Center Affiliation, Jamaica, New York and the School of Medicine, Health Sciences Center, State University of New York at Stony Brook, New York
⁴ Department of Medicine, Cardiology Division and Department of Surgery, Cardiovascular Division, Long Island Jewish-Hillside Medical Center, New Hyde Park, New York, Queens Hospital Center Affiliation, Jamaica, New York; School of Medicine, Health Sciences Center, State University of New York at Stony Brook, New York

Twenty-one patients are presented who demonstrated localized late systolic bulging of the left ventricular wall. All were referred because of angina pectoris. Left ventricular angiography was performed while recording simultaneously the electrocardiogram, thus permitting exact timing of events during systole. Eleven patients (group 1) had a normal left ventricular pattern during early and mid-ejection, whereas ten patients (group 2) had asynergy noted at the onset of ejection. Both groups had, during the late phase of ejection, a localized anterior or apical bulge become evident, which, in some patients, became more pronounced during early diastole. No patient in group 1 had evidence of a transmural myocardial infarction, whereas half the patients in group 2 had an old inferior wall myocardial infarction. Ischemic T wave changes in the anterior leads were noted in a total of nine patients. Selective coronary angiograms demonstrated significant coronary artery disease in 16 patients, whereas five patients had normal coronary angiograms. Hemodynamic and left ventricular volume studies were essentially normal, except for elevated left ventricular end-diastolic pressure in eight of the patients with coronary artery disease. Five patients, after aortocoronary bypass surgery, revealed, on restudy, a normal contractile pattern. The late systolic bulge present in our patients is consistent with asynchronous contractions, resulting in early relaxation of the involved segment.

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