Detection of Hypokinesis by a Quantitative Analysis of Left Ventricular Cineangiograms

A method for detecting left ventricular hypokinesis is proposed. It involves superimposition of left ventricular silhouettes traced from 30 degree right anterior oblique cineangiograms, correcting for thoracic cage motion, descent of the aortic valve and rotation of the apex. Normal values for the percent of systolic motion of seven endocardial segments have been established from measurements in 20 patients, permitting a statistical definition of hypokinesis. The use of this quantitative method has been compared with visual inspection of ventriculograms (qualitative method), resulting in differences in definition of hypokinetic segments by the two methods in 13 of 16 patients with coronary heart disease. When the quantitative method was used, only one hypokinetic segment was found which did not correspond to an obstructive coronary lesion while six such segments were defined using the qualitative method. In four patients segments thought to be hypokinetic (qualitative method) appeared to be akinetic (quantitative method). In six patients with cardiomyopathy, thought to have diffuse hypokinesis, all seven left ventricular segments were hypokinetic in only three patients. The use of a quantitative method appears to be essential to the proper interpretation of left ventricular wall motion and particularly to the detection of hypokinetic segments.