Comparison of early systolic and holosystolic ejection phase indexes by contrast ventriculography in patients with coronary artery disease

To compare the discriminant ability of early systolic and holosystolic ejection phase indexes to detect abnormalities of left ventricular performance, the contrast ventriculograms of 20 control patients and 55 patients with coronary artery disease (at least 70% stenosis of one or more major coronary arteries) were analyzed. All subjects were studied to evaluate chest pain, and none was taking propranolol or antihypertensive drugs. Several ejection phase indexes were evaluated, using holosystole, the first third of systole and the first half of systole. In the patients with coronary disease, 14 (25%) had one-vessel disease, 13 (24%) had two-vessel disease and 28 (51%) had three-vessel disease. In general, the ejection fraction was more useful than indexes based on velocity of ejection. Ejection fraction was lower in the coronary patients than in normal subjects for holosystole (0.62 ± 0.14 vs 0.70 ± 0.08, p < 0.01), for the first third of systole (0.20 ± 0.06 vs 0.36 ± 0.06, p < 0.001), and for the first half of systole (0.34 ± 0.09 vs 0.53 ± 0.10, p < 0.001). Fourteen patients with coronary artery disease (25%) had a depressed holosystolic ejection fraction, 36 (65%) had a depressed first-half ejection fraction and 52 (94%) had a depressed first-third ejection fraction. It is concluded that early phase indexes, particularly the first-third ejection fraction, are more useful than holosystolic indexes in identifying resting abnormalities of left ventricular function.