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Haemodynamic events in right and left ventricle during angina induced by atrial pacing
Insights
Atrial pacing revealed that elevated left ventricular end-diastolic pressure during angina in coronary artery disease patients did not correlate with coronary angiography findings.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Coronary artery disease (CAD) affects myocardial oxygen supply and demand.
- Understanding ventricular pressure dynamics during induced angina is crucial for risk stratification.
Purpose of the Study:
- To investigate the hemodynamic response, specifically ventricular end-diastolic pressures, during atrial pacing-induced angina in patients with and without coronary artery disease.
Main Methods:
- 37 patients underwent atrial pacing during coronary angiography.
- Ventricular end-diastolic pressures (right and left) were monitored.
- Pacing continued until angina or a maximum heart rate of 166/min was reached.
Main Results:
- In patients with normal coronaries or without angina, ventricular pressures remained steady or decreased with pacing.
- 14 patients with CAD experienced angina, with 14 showing a rise in left ventricular end-diastolic pressure.
- Right ventricular pressure changes often mimicked left ventricular changes during angina.
Conclusions:
- Left ventricular end-diastolic pressure elevation during pacing-induced angina in CAD patients is a significant finding.
- This pressure change may not correlate with the severity of angiographically visualized coronary artery disease.
- Right ventricular hemodynamic responses appear to parallel left ventricular responses during angina.
Abstract:
Atrial pacing to the point of angina or up to a maximum rate of 166/min was carried out in 37 patients during coronary angiography. In 9 patients with normal coronary arteries both the right and left ventricular end-diastolic pressures fell remained steady with increasing heart rate. The same response was observed in 14 patients with angiographically proven coronary artery disease. In the remaining 14 patients with provencoronary artery disease the end-diastolic pressure in the left ventricle rose at the point when the patient experienced angina. In 10 of this latter group there was a simultaneous rise in the right ventricular end-diastolic pressure. In 4 patients the rise in end-distolic pressure was seen in the left ventricle only. The haemodynamic events in the right ventricle during angina appeared in most cases to mimic the events occurring in the left ventricle. There was no correlation between the angiographic findings and the changes in end-diastolic pressure in the two ventricles during angina.