Evolution of Left Ventricular Dysfunction

The evolution of left ventricular dysfunction in 36 patients with coronary artery disease and no interim surgical intervention was studied over a mean interval of 26 months (range 6-71 months). The ejection fraction decreased 0.08 (p < 0.001) on the average in patients with coronary artery disease progression. However, progression of coronary artery disease was not accompanied by a decrease in ejection fraction in every patient. Though deterioration in left ventricular function in the entire group was associated with the presence of new collateral vessels and interim arteriographic total occlusion, collaterals and occlusion did not imply a decline in ejection fraction of 0.10 or more in the individual patients. The ejection fraction tended to fall in patients with progression of arterial disease and no occlusion or interim infarction. Patients with interim myocardial infarction were more likely to have a decrease in ejection fraction of 0.10 or more (p < 0.05). Isolated left anterior descending coronary artery occlusion in five patients resulted in marked segmental contraction abnormalities and a fall in ejection fraction not observed with occlusion of the other major coronary vessels. Progression of muscle damage may result from intrinsic changes induced by primary injury, recurrent ischemic episodes or unperceived infarction. The evolution of dysfunction in association with changes in coronary anatomy, clinical events or as the consequence of primary injury should be considered in the evaluation of the efficacy of therapeutic interventions.