Vectorcardiographic diagnosis and electrocardiographic correlation in left ventricular asynergy due to coronary artery disease. I. Severe asynergy of the anterior and apical segments.

The transverse plane QRS loop vectorcardiogram (VCG) was analyzed in 102 consecutive patients, angiographically proven to have coronary artery disease (CAD), whose right anterior oblique left ventriculogram showed severe asynergy (akinesis or marked hypokinesis) of the anterior and apical segments. Eighty-four of the 102 loops were considered to be diagnostic of severe asynergy because similar loops were not found in patients with CAD with less severe asynergy of either or both segments or in normal control subjects. Eighty-two of the 84 showed a uniformly abnormal pattern. Posterior vectors exhibited partial or complete clockwise "rotation" and were much more prominent than early anterior forces. In fact, the latter were often absent. In the other two VCG's at least the early half of the loop displayed prominent anterior vectors. The ECGs showed marked variability of the QRS in leads V-2-V-6. Abnormal Q waves were present in only 63 of the 102. The numbers of these leads showing abnormal Q waves varied from one to all of these positions.