Abstract
Regional and global cardiac function was evaluated by monitoring the left ventricular (LV) wall motion and the hemodynamic parameters during attack of variant angina. In 12 patients (pts) with variant angina, coronary spasm was evoked with ergonovine maleate and LV wall motion was serially observed with 2-D and M-mode echocardiography during angina. In all pts, LV asynergy was observed and appearance of the asynergy consistently preceded the onset of ST-T changes (106±90sec). Elevation of pulmonary arterial end-diastolic pressure(PAEDP)occurred simultaneously with the appearance of asynergy. During attack, the mean value of stroke index(SI) was unchanged (50.3±6.8ml/beat/m to 49.0±9.3ml/beat/m). However, in 3 pts with large non-contractile segment(NCS), SI decreased. PAEDP remarkably elevated(8.8±2.0mmHg to 17.0±3.4mmHg). Heart rate(67±9 beat/min to 67±11 beat/min) and systolic arterial pressure were unchanged (144±19 mmHg to 145±29mmHg). In 10 pts, mean systolic velocity increased in non-ischemic region (27.7±11.2mm/sec to 33.0±13.0mm/sec), whereas decreased in ischemic region (30.8±6.9mm/sec to 17.2±7.5mm/sec).
Thus, we conclude that the occurrence of abnormal wall motion preceded the electro-cardiographic changes, and the impairment of the regional function during attack in the ischemic region was fully compensated by the hyperkinetic motion of the non-ischemic region and therefore the LV function as a whole was maintained in the cases with small NCS.
