Improvement of systolic and diastolic left ventricular wall motion by serial echocardiograms in selected patients treated for unstable angina. The purpose of the study was to evaluate the effect of antiischemic treatment on left ventricular function in selected patients with unstable angina pectoris that was due to severe proximal left anterior descending coronary artery narrowing and to identify subgroups liable to an adverse outcome (mean term 2.7 years). Effect of antiischemic treatment on systolic and diastolic left ventricular wall motion was studied in 35 patients who had unstable angina pectoris and an electrocardiogram that indicated severe proximal left anterior descending coronary artery narrowing. Treatment consisted of either a revascularization procedure (17 patients) or antianginal drug therapy (18 patients). All patients underwent a two-dimensional echocardiographic study within 48 hours (mean 20 hours) of entry into the study. This study semiquantitatively analyzed systolic performance of the ischemia-related segments by calculation of a total wall motion score. In 16 patients this investigation was combined with a continuous detailed recording of only the apical interventricular septal wall motion. This detailed study included measurements for regional function by providing a typification of the pattern of systolic and early diastolic excursion of the endocardial border of the apical interventricular septum. A repeat ultrasonic study was performed at least 1 month (median 2 months, 7 days) after admission. Results of the systolic wall motion analyses of all 35 patients showed, in both treatment groups, a significant improvement in systolic wall motion of the anterior and apical segments (mean total wall motion score at early study vs late study: revascularization, 6.9 vs 2.2 and medical therapy, 4.6 vs 1.0). 