ABSTRACTS

DETECTION OF LEFT VENTRICULAR REGIONAL WALL MOTION ABNOR- MALITIES: COMPARISON OF AREA, CHORD AND RADIAL METHODS. H. Gelberg. MD; 8. Brundage, MD, FACC; S. Glantz, PhD; S. Rubin, MD; T. Hiyashi. PhD; W. Parmley, MD, FACC; Uni- versity of California, San Francisco, California.

A universally accepted system for evaluation of left ventricular (LV) wall motion abnormalities (WMA) on cin6 ventriculogram (Vgram) has not been devised. We examined 3 systems of WM analysis using biplane Vgram prior to auto- mating oni system for clinical use. We established normal range* (i.e., within 2 standard deviations [StDV]) for each system in each region of the LV using 10 Vgrams of patients with normal coronary arteriograms and no WMA. We examined 7 Vgrams of varying degrees of WMA. All methods are: based on percent change (A) from end-diastole (D) to end-systole (S); take Into account normal systolic anteri- or rotation; and, examine the right anterior oblique (RAO) and left anterior oblique (LAO) projections. The methods are shown below: Area Chord Radial

Area method: [D area of each region-d area]tD area-area e- jection fraction. Chord and radial methods: [D length of line-S lengthliD length-ejection fraction shortening. The changes with ejection were normalized in each method by: [A-mean change of a given normal region]+StDV for that re- gion (i.e., 2 score). The largest 2 score would indicate the greatest separation between normals and abnormals. The average abnormal region was 2.3 StDVs from the normal by the area method but only.l.4 by the chord and 1.1 by the radial methods.

The area method is most sensitive in detecting LV WMA and therefore this system was selected and programmed on a desk top calculator for clinical use.

SEGMENTAL LEFT VENTRICULAR AKINESIS IN SINGLE VESSEL CORONARY DISEASE. Lawrence Griffith, MD, FACC; Louise Grunwald; Joseph Gerry, MD; Stephen Achuff, MD; Johns Hopkins University, Baltimore, Marylond

Segmental left ventricular akinesis(LVA) can be correlated with Z 70% narrowing of the left anterior descending(LAD), right(RCA) or left circumflex(CIRC) coronary ortery(CA).

Fifty-six patients(pts) with single vessel disease(SVD)(one ortery narrowed Z 70%, other arteries 4 40%) and one or more LVA segments were studied. LV angiographic silhouettes in right and left anterior oblique projections were divided into 11 segments:

‘LADE-

Patients With Akinetic Seament Seg.No.1 2 3 4 5 6 7 -8 9 1011

LAD 28pts 1 23 21 0 0 0 0 22pts 10 21 0 0 RCA 21pts 0 0 0 6 13 18 19 12pts 0 0 10 CIRC 7ats 0 0 0 2 6 6 0 7IJts 0 0 44 -LVA in’pts with SVD-LAD was limited to se& 2,3,8,9 (PC 0.01). In SVD-RCA, 18/21 had LVA of seg 6,7. In SVD-CIRC, 6/7 had LVA of segs 5,6. LVA of seg 10 correlated with disease of the left posterior descending branch of either RCA or CIRC (P( 0.001). In SVD-CIRC marginal, LVA is limited to seg 11 (P< 0.001).

This correlation between segmental LVA and the perfusing CA has proved useful in assigning priorities for coronary bypass by estimating the “viability” or scar replacement in the distribution of a narrowed coronary artery.

ULTRASTRUCTURAL CHANGES OF ISCHEMIC MYOCARDIUM IN PATIENTS WITH THE INTERMEDIATE SYNDROME Monty M. Bodenheimer, MD, FACC; Vidya S. Banka, MD; Robert G. Trout, MD, FACC; George Hermann, MD; Homayoon Pasdar, MD, FACC; Richard H. Helfant, MD, FACC, Presby- terian-university of Pennsylvania Medical Center, Philadelphia, Pennsylvania

To better understand the state of the myocardium in pa- tients with the intermediate syndrome (ST-T wave changes, chest pain of 224 hrs, normal enzymes and no new Q waves) transmural biopsies were obtained at the time of open heart surgery in 8 pts from the ischemic area as demarca- ted on epicardial electrograms prior to bypass. All pts had similar light and electron microscopic findings dis- tributed transmurally. Light microscopy revealed prcmi- nent hypercontraction bands. There was no evidence of co- agulation necrosis or acute inflammatory responses. Ul- trastructurally, all areas examiwd displayed varying stages of fiber contraction with no I bands discernible. Electron dense, amorphous contraction bands derived from collapsed Z band areas irregularly interrupted the order- ly cross striation of the fibers. Intra and extracellu- lar edema displaced both muscle fibers and individual myo- fibrils exhibiting focal myofibrillar dissolution. Scat- tered eosinophilic dense bodies, often membrane bound, commonly showed close association with swollen, atypical mitochondria. Vacuolated foci frequently punctuated the mitochondria. Myocardial fiber nuclei displayed peripher- ally condensed chromatin. Small vascular channels were unaffected and glycogen was not notably depleted in most areas. Post-operatively none of the 8 pts developed Q waves. Thus, patients with the intermediate syndrome ul- trastructurally manifest myofibrillar degeneration con- sistent with experimental electron microscopic findings in the periphery of ischemic or reperfused myocardium.

ALTERATIONS IN CALCIUM CONTENT OF CORONARY SI- NUS BLOOD DURING CORONARY ARTERIOGRAPHY. AC- CENTUATED MYOCARDIAL DEPRESSION BY CONTRAST MA- TERIAL IN THE PRESENCE OF HYPOCALCEMIA. Charles B. Higgins, M.D.; Walter Schmidt; Uni- versity of California, San Diego, California.

Electromechanical dissociation is a rare but fatal complication of coronary arteriography. Since electromechanical dissociation is a known consequence of hypocalcemia, we investigated the variations in coronary sinus total (T) (fluorometric method) and ionic (I) calcium (C) (ion specific electrode) during coronary arte- riography in 17 dogs. Renografin (R) (no cal- cium ions) induced decreases in dp/dt (-29 +_ 4%) dp/dt/LVPqD (-18 f 4%), TC C-36 + 3%), IC (-47 ? 6%), and hematocrit (-47 * 5%). IC/TC decreased (-15 f 4%) during peak opacification suggesting chelation by R. After induced hypo Ca (EDTA infusion) and myocardial depression (pentobarbital), the above parameters declined to a greater extent, persisted longer, and in 10 dogs with hypo C caused prolonged hypoten- sion and pulsus alternans. Isopaque 370 (con- tains Ca++) increased dp/dt (+28 f 1%) dp/dt/ LVP40 (+20 + 4%), IC (+7 f 2%), IC/TC; and de- creased TC (-9 ? 2%) and hematocrit. The posi- tive inotropic effect was greater in the pres- ence of induced hypo Ca and myocardial depres- sion. Thus currently used contrast material causes myocardial hypo Ca by a dilutional and chelating effect, which contributes to the negative inotropic effect. Ca++ containing contrast material reverses these effects.

414 February 1978 The American Journal of CARDIOLOGY Volume 41