The left ventricular systolic ejection phase was cineangiographically analyzed in an attempt to evaluate left ventricular performance. Forty-eight patients were classified into five groups: (1) 9 controls; (2) 5 patients with PMD (congestive type) (COCM); (3) 9 patients with PMD hypertrophic type) (HCM), (4) 9 patients with ischemic heart disease (IHD); and (5) 16 patients with mitral stenosis (MS). The rate of volume change (deltaV/deltat) and the volume change as a percentage of stroke volume (deltaV/SV) in patients with COCM and IHD were lower in the early systole and higher in the mid-systole as compared with the control group. Normalized systolic ejection rate (NSER) and velocity of circumferential fiber shortening (Vcf) for the early and late systole were significantly lower in patients with COCM and IHD than in the control group. In two patients with IHD in whom normal indices of left ventricular performance and no asynergy were observed, NSER and Vcf were normal in the late systole but were significantly lower in the early systole. In all 48 patients, deltaV/deltat, deltaV/SV, NSER and Vcf were compared statistically with conventional ejection phase indices and isometric phase indices. delthV/SV for the midstystole showed a negative correlation with EF, MNSER and mVcf. NSER and Vcf for all three phases showed a good correlation with Vmax, max dp/dt and R-max dp/dt but a better correlation with EF, MNSER and mVcf. It was concluded that NSER and Vcf for the early systole were sensitive indices of left ventricular performance and may be utilized to detect subtle depression of left ventricular performance.