Left Ventricular Dyssynergy

Few data exist regarding the consequences of abnormalities of segmental contraction on intraventricular flow patterns. The development of color Doppler flow imaging has now permitted the visualization of intraventricular blood flow patterns. Therefore, we performed Doppler flow mapping in 41 patients (12 with normal left ventricular contraction, eight with hypokinesis or akinesis, and 21 with dyskinesis) and compared these findings with left ventriculography. Systolic blood flow by Doppler mapping in subjects with normal ventricular contraction was characterized primarily by flow through the left ventricular outflow tract and into the aorta. In patients with dyskinesis, paradoxical systolic flow toward the abnormal segment was present, and persisted for at least 50%o of systole in 18 of 21 patients. Mean duration of paradoxical flow in dyskinetic patients was 77% of systole. Paradoxical flow was also observed in two of five patients with akinesis but in no patients with hypokinesis. A good correlation was observed between the duration of paradoxical systolic flow and indexes of regional wall motion (radian shortening of the involved myocardium) (r=0.77) and global ejection fraction derived from cineangiography (r=0.79). Correlations between the area of the paradoxical systolic flow stream in midsystole and indexes of left ventricular function were less close, with r equaling 0.57 for both regional wall motion and ejection fraction. Thus, paradoxical systolic flow can be detected in most patients with left ventricular dyskinesis, and correlates with the magnitude of regional and global left ventricular dysfunction by cineangiography. (Circulation 1990;82:95-104)