SUMMARYThe value of nitroglycerin in determining the potential reversibility of asynergy was examined in 35 patients with coronary heart disease. Ventriculograms performed at rest and after sublingual nitroglycerin were analyzed for (1) location of asynergy relative to distribution of the 3 major coronary arteries and (2) Received NMarch 11, 1974; accepted for publication March 25, 1974. 108 determine both the risk and potential benefits of bypass surgery. 12 The present study was undertaken to determine whether sublingual nitroglycerin, by pharmacologically improving the balance between oxygen supply and demand, unmasks residual contractile ability of asynergic zones. In addition the effects of nitroglycerin were compared with the results of coronary bypass surgery on wall motion in the same left ventricular zones. MethodsStudies were performed in 35 patients undergoing cardiac catheterization for evaluation of coronary heart disease.Criteria for admission to the study were: (1) asynergy on ventriculography (defined as a localized abnormality of left ventricular contraction), (2) significant (greater than 75%) obstruction of one or more of the three major coronary arteries, (left anterior descending, right and circumflex arteries), and (3) absence by catheterization of other etiologic heart disease. All patients were postabsorptive and premedicated intramuscularly with 50 mg nembutal, 50 mg demerol, and 0.4 mg atropine.Right heart catheterization was performed via an antecubital vein cutdown and left heart catheterization either via a right brachial arteriotomy or percutaneously utilizing a femoral artery. Following recording of left ven-

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