Comparison of segmental and global ejection fraction in ischaemic heart disease.

In order to evaluate whether segmental ejection fraction (SEF) is a better index of left ventricular (LV) performance than global ejection fraction (EF), 25 patients with significant coronary stenosis and normal EF were studied. SEF was estimated from the LV cineangiogram after dividing the LV into eight segments by means of a long axis and three equally spaced chords perpendicular to it. The area of a given segment was measured in the end-diastole and the end-systole and SEF was calculated by determining the percent decrease in area for each segment. 12 out of the 25 patients presented hypokinesis, akinesis or dyskinesis of at least two segments; the inferior apical and both diaphragmatic segments were the regions most frequently affected. In 7 patients, these abnormalities were compensated by hyperkinesis of two or three other segments, whereas in the remaining 5 patients contraction abnormalities were not accompanied by hyperkinesis in spite of a normal EF. It is concluded that SEF is a more sensitive index of regional LV function than EF in patients with ischaemic heart disease.

Segmental ejection fraction in normal subjects.

Following a modification of the area method described by Gelberg et al., left ventricular regional wall motion was studied in 30 normal subject. The left ventricular cineangiograms were filmed in the right anterior oblique projection at 48 frames/s after injection of 76% sodium-meglumine diatrizoate. The end-diastolic and end-systolic frames were each divided into 8 regions using a grid formed by longitudinal axis, which was traced from the midpoint of the aortic valve to the apex, and three equally spaced perpendiculars to the long axis. Segmental ejection fraction was estimated by determining the percent decrease in each segment area in end-systole with respect to the end-diastolic area. The mean values +/- S. D. obtained for each segment were: anterobasal 58 +/- 14%; anterolateral-proximal 59 +/- 6%; anterolateral-distal 58 +/- 4%; apical-superior 59 +/- 8%; apical-inferior 58 +/- 7%; diaphragmatic-distal 58 +/- 9%; diaphragmatic-proximal 55 +/- 6%; and posterobasal 42 +/- 15%. The values obtained are useful for comparison when evaluating left ventricular performance in patients.