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The degree of inward motion at mid-ejection was examined for seven segments on the silhouettes of left ventriculograms taken in the 30°RAO projection in patients with normal coronary arteries. The pattern of wall motion described in these patients was used to distinguish abnormalities in mid-systolic wall motion. WITHIN THE PAST DECADE the more widespread use of left ventricular cineangiography in the study of patients with coronary heart disease has led to descriptions of regional abnormalities of contractile motion. Such abnormalities have been found commonly1-5 and it has been shown that their locations frequently correspond to sites of coronary artery obstruction.1' 3In our experience and in the experience of others,2 however, a normal contraction pattern may be found in the presence of significant obstructive coronary artery disease when only the onset and the end of the ejection phase of systole are analyzed in the left ventricular cineangiogram. We have observed that many patients with these angiographic findings, that is, obstructive coronary artery disease and apparently normal patterns of left ventricular contraction, have localized abnormalities of contraction which occur only during the first half of ejection. Thus, when the motion at mid-ejection is ex- Received June 25, 1974; revision accepted for publication March 13, 1975. 238 amined, delayed, paradoxical, or no motion may be found. The investigation of these contraction abnormalities is the substance of our report. MethodA retrospective and prospective analysis was made of selective coronary and left ventricular cineangiograms performed in our laboratory and two groups of patients were selected. One group was composed of 20 patients who had chest pain with angiographically normal coronary arteries. Normal values for parameters of left ventricular function were defined as being within the group range for these patients: ejection fraction > 0.59, end-diastolic volume < 95 ml/M2, and end-diastolic pressure < 15 mm Hg. Normal values for percent shortening of seven endocardial segments on the 300 RAO left ventriculogram from the onset of ejection to end-systole were defined from the findings in these 20 patients, as being no greater than two standard deviations from the group mean.6The second group was composed of 42 patients with coronary artery disease with 70% or greater luminal obstruction in at least one major coronary artery branch in the presence of normal left ventricular end-diastolic volume and pressure, a normal ejection fraction, and a normal end-systolic contraction pattern as defined above. All of the patients with coronary artery disease had chronic stable angina pectoris and no evidence of congestive heart failure. Eight patients who underwent aortocoronary saphenous vein graft surgery were selected from the group on the basis of normal postoperative values for left ventricular ejection fraction, end-diastolic volume, and end-systolic wall motion. Their postoperative left ventriculograms were obtained an average of 61 days follow...

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