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Detection of coronary artery disease by analysis of ventricular filling
Insights
Assessing rapid left-ventricular diastolic filling in coronary artery disease patients with normal systolic function is unreliable. Age and heart rate significantly impact results, limiting diagnostic sensitivity for individual patient detection.
Area of Science:
- Cardiology
- Nuclear Medicine
- Physiology
Background:
- Coronary artery disease (CAD) can affect cardiac function.
- Left-ventricular (LV) diastolic filling is a key indicator of cardiac health.
- Previous studies suggested diastolic filling abnormalities in CAD patients with preserved LV systolic function.
Purpose of the Study:
- To reevaluate the utility of rapid left-ventricular diastolic filling assessment in detecting coronary artery disease.
- To investigate the influence of age and heart rate on diastolic filling parameters in patients with CAD and normal LV systolic function.
Main Methods:
- Radionuclide ventriculography was used to assess LV diastolic filling.
- Studied 30 healthy subjects and 44 patients with CAD and normal LV ejection fractions.
- Analyzed peak filling rate and time to peak filling rate, considering age and heart rate.
Main Results:
- No significant difference in peak filling rate (p=0.08) or time to peak filling rate between CAD patients and controls.
- Sensitivity for detecting CAD was very low (0%-9%) when appropriate age-matched controls were used.
- Using an inappropriate young control group led to perceived differences, masking the low sensitivity.
Conclusions:
- Rapid left-ventricular diastolic filling analysis is not a reliable method for detecting individual CAD patients with normal LV ejection fractions.
- Failure to account for age and heart rate may explain discrepancies in previous reports.
- Further research should incorporate age and heart rate normalization for accurate diastolic function assessment in CAD.
Abstract:
Rapid left-ventricular (LV) diastolic filling assessed by radionuclide ventriculography is reevaluated in patients with coronary artery disease and normal LV systolic function considering the effects of age and heart rate. Thirty normal subjects were studied along with 44 patients with coronary artery disease and normal LV ejection fractions. The peak filling rate was not quite significantly different between the controls and patients (2.67 +/- 0.95 EDV/sec versus 2.25 +/- 0.65 EDV/sec, p = 0.08), and the time to peak filling rate was not different. When an inappropriate young control group was compared with coronary disease patients aged 40-65 yr, large differences in peak filling rate were seen. Sensitivity for detection of disease was very low (0%-9%) except when the inappropriate young control group was used. Thus, analysis of rapid diastolic filling cannot detect individual patients with coronary disease who have normal LV ejection fractions. Previous reports to the contrary may have suffered from failure to include the effects of age and heart rate.