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Left ventricular dysfunction causing ischemia in patients with patent coronary arteries

Thach Nguyen1, Hoang Do2, Tri Pham2

  • 11 Cardiology Research Department, Methodist Hospital, Merrillville, IN, USA.

Perfusion
|August 22, 2017
PubMed

Insights

New heart failure (HF) with ischemic EKG changes in patients with clear arteries is linked to elevated left ventricular end diastolic pressure. Lower aortic diastolic pressure can worsen this ischemia.

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.
Abstract

Keywords:
EKGangiographycoronary artery diseaseheart failureleft ventricular dysfunction

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