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[Hemodynamic profile of patients with normal coronary cineangiography]
Insights
A significant percentage of patients with suspected coronary artery disease have normal coronary arteries. Further hemodynamic profiling is crucial for these individuals, especially those with hypertension or left ventricular hypertrophy.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Hemodynamics
Context:
- Selective coronary arteriography is a key diagnostic tool for obstructive coronary disease.
- A notable proportion of patients undergoing this procedure exhibit normal coronary arteries, necessitating further investigation.
- Understanding the hemodynamic profile of these patients is essential for accurate diagnosis and management.
Purpose:
- To determine the hemodynamic profile of patients with apparently normal coronary arteries.
- To analyze parameters including left ventricular pressures, volumes, ejection fraction, wall thickness, mass, and mitral valve function.
- To identify subgroups within this patient population based on specific hemodynamic alterations.
Summary:
- Review of 1474 coronary arteriograms identified 19.1% of patients with normal coronary arteries.
- These patients, with a mean age of 47, were analyzed for various hemodynamic parameters.
- Eight distinct patient groups were identified based on hemodynamic findings, including systemic hypertension and abnormal myocardial contraction.
Impact:
- Highlights the importance of comprehensive hemodynamic assessment in patients with normal coronary arteries.
- Suggests a need for pre-procedural noninvasive stress testing to detect provoked ischemia.
- Emphasizes the particular relevance for females with specific risk factors like hypertension and left ventricular hypertrophy.
Abstract:
The authors reviewed 1474 consecutive selective coronary arteriograms performed on patients with suspected coronary insufficiency for the diagnosis of obstructive coronary disease and found 281 (19.1%) cases of apparently normal coronary arteries. These patients presented mean age of 47 +/- 10 years; they were 135 (48%) males and 146 (52%) females. The objective of this study was to obtain the hemodynamic profile of these patients for the following parameters: a) aortic and left ventricular pressures; b) volumes, ejection fraction, segmentary contraction, wall thickness and mass of left ventricle; c) morphology, mobility and competence of the mitral valve. Eight groups of patients were selected: 1) without hemodynamic alterations - 18.9%; 2) with systemic arterial hypertension - 48.7%; 3) with abnormal myocardial contraction - 16.7%; 4) with idiopathic left ventricular hypertrophy - 6.4%; 5) with mitral valve prolapse - 2.5%; 7) with myocardial bridge of the left anterior descending coronary artery - 1.8%; 8) with coronary arterial microfistula of the left ventricle - 0.4%. It is desirable to determine before situations of cardiac emergencies, whether provoked ischemia, as detected by noninvasive stress testing, is present before the performing coronary arteriography in patients, specially females, with systemic arterial hypertension, left ventricular hypertrophy, disorders of ventricular contraction or mitral valve prolapse.