Quantitative angiographic analysis of the left ventricle in patients with isolated rheumatic mitral stenosis.

It has been suggested that impaired left ventricular performance in patients with rheumatic mitral stenosis results from a localized abnormality of wall motion. Accordingly, in io patients with isolated mitral stenosis who had no evidence of coronary arterial disease, the ejection fraction and the mean rates of circumferential fibre shortening (mean Vcf) both at the minor equator and at the base of the left ventricle were analysed. Ejection fractions ranged from o 42 to o 86 and were abnormal (< os6) in 3 subjects. At the minor left ventricular equator mean Vcf ranged from o -6o to 4 '30 circumferences (circ)/sec and was abnormal (< I *2 circlsec) in 4 patients; mean Vcf at the base was abnormal in 6 of the io patients. Radiographic projection did not affect the separation of normalfrom abnormal mean Vcf. Reduction of mean Vcf confined to the base of the left ventricle was seen in 2 patients, both of whom had a normal ejection fraction and a normal mean Vcf at the minor equator. However, of the remaining 4 patients with a reduced value for mean Vcf at the base, all had reduced mean Vcf at the minor equator and 3 also had a depressed ejection fraction. These data are consistent with the view that a generalized abnormality of myocardial mechanical performance is responsible for the occurrence of left ventricular dysfunction in some patients with mitral stenosis.