Left ventricular dysfunction causing ischemia in patients with patent coronary arteries

Area of Science:

• Cardiology
• Internal Medicine
• Physiology

Background:

• New onset heart failure (HF) necessitates coronary artery disease assessment.
• Investigating new HF onset with ischemic electrocardiograph (EKG) changes and chest pain in patients with unobstructed coronary arteries.

Purpose of the Study:

• To clarify the mechanistic causes of new onset HF.
• To understand HF development in patients with patent coronary arteries but ischemic EKG changes.

Main Methods:

• Retrospective review of 20 patients (Group A) with new HF, chest pain, ischemic EKG changes, and negative coronary angiogram (CA).
• 1:1 matched cohort (Group B) for validation.
• Analysis of left ventricular end diastolic pressure (LVEDP), aortic diastolic (AOD) pressure, and coronary perfusion pressure (CPP).

Main Results:

• Group A showed higher LVEDP and lower AOD compared to Group B.
• Low CPP (<20 mmHg) with elevated LVEDP and low AOD correlated with deep T wave inversion.
• Mild ST depression was noted with CPP between 20-30 mmHg; non-specific changes or normal EKG with CPP >30 mmHg.

Conclusions:

• In HF patients with ischemic EKG changes, low aortic diastolic pressure exacerbates ischemia when left ventricular end diastolic pressure is elevated.