Abnormalities of left ventricular function associated with prior acute myocardial infarction.

Selective coronarography, left ventricular cineangiography were performed three to six months after acute myocardial infarction in 45 patients. Simultaneously, stroke volume (SV), enddiastolic (EDV) and endsystolic volume (ESV), ejection fraction (EF) and left ventricular enddiastolic pressure (LVEDP) were determined. LVEDP was measured at rest and after static (handgrip) exercise. According to the type of the LV abnormality patients were divided in three groups: 1. without LV abnormality (5 patients) 2. asynergy (15 pts) and 3. aneurysm (25 pts). The data were reviewed separately in patients where abnormalities of LV were associated with angina pectoris. The degree of coronary obstruction and the type of LV abnormality did not disclose any correlation. LVEDP at rest was in normal limits in patients in group 1 and 2, elevated in patients with aneurysm. (LVEDP: 15, 15 and 25 mmHg resp.) After handgrip exercise LVEDP increased in each group: 21, 22, 32 mm Hg. SV: decreased significantly in LV aneurysm (53 ml/beat). EDV was 50 ml in patients with asynergy and 118 ml in those with aneurysm. ESV was in normal limits when asynergy was present, 35 ml in patients without abnormality and 118 ml in LV aneurysm. EF was 0.66 and 0.65 in group 1 and 2, in group 3 (aneurysm) this value was 0.49 (significantly lower). The extent of shortening of the longitudinal and transverse diameters were significantly diminished in each group. When angina was associated with LV asynergy a higher SV was observed, when angina was associated with aneurysm, SV and EF were decreased. The conclusion from these data can be drown that the compromised LV after prior AMI works with a different mechanism, according the type (and degree) of abnormality.