Relationship between regional myocardial perfusion and the presence, severity and reversibility of asynergy in patients with coronary heart disease.

SUMMARY In this study, the interrelationship of regional myocardial perfusion at rest and after exercise, the presence, severity and reversibility of asynergy and the severity of the corresponding coronary arterial obstruction was examined. Forty-five patients underwent exercise testing with thallium-201, cardiac cathe-terization including intervention (nitroglycerin) ventriculography and coronary arteriography. Of the 45 pa-tients, 13 were normal by catheterization while 32 had coronary heart disease (CHD). Of the 32 with CHD, 21 had asynergy and 11 had normal ventricular contraction. Eighteen of 21 patients with asynergy also had a myocardial perfusion abnormality after exercise, while only three of the 11 without asynergy had a perfu-sion abnormality (P 0.001). Of the 21 hypokinetic zones, only 67 % had a myocardial perfusion abnormal-ity, while all of the akinetic and dyskinetic zones had a perfusion defect (P 0.025). Twenty-seven left ventricular zones demonstrated perfusion abnormalities after exercise, of which 19 had either normal or improved myocardial perfusion at rest. Fifteen of these 19 had reversible asynergy on nitroglycerin ventriculography while three had normal contraction. In contrast, the eight zones with myo-cardial perfusion defects, both at rest and with exercise, all had associated asynergy which was irreversible. A significant relationship was also observed between the severity of the coronary arterial obstruction, asyn-ergy and a perfusion abnormality. Thus, of 39 myocardial zones supplied by 2 90 % coronary arterial lesions,