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Left ventricular diastolic filling abnormalities in left anterior descending disease
Insights
Coronary disease patients with normal systolic function may have normal diastolic filling (DF) unless they have significant left anterior descending artery (LAD) obstruction. LAD disease impacts DF, but these changes lack predictive value.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Reduced left ventricular diastolic filling (DF) is observed in coronary disease (CD) patients with normal left ventricular systolic function (NLVF).
- Previous studies often included confounding factors like hypertension or hypertrophy, limiting conclusions about isolated CD effects on DF.
- DF abnormalities in NLVF patients without these factors were primarily linked to severe left anterior descending artery (LAD) obstruction (>75%).
Purpose of the Study:
- To investigate left ventricular diastolic filling (DF) in patients with normal left ventricular systolic function (NLVF) and varying degrees of coronary disease (CD).
- To specifically assess the impact of left anterior descending artery (LAD) obstruction on DF in NLVF patients, excluding other cardiac conditions.
Main Methods:
- Utilized high-frame-rate (60 frames/sec) biplane contrast ventriculography to analyze left ventricular filling curves.
- Evaluated 21 healthy controls (Group 1), 17 NLVF CD patients without LAD disease (Group 2), and 18 NLVF CD patients with LAD disease (Group 3).
- Measured peak filling rate (PFR) in end-diastolic volumes per second (EDV/S).
Main Results:
- Group 3 (LAD disease) showed significantly reduced PFR (3.00 +/- 0.51 EDV/S) compared to Group 1 (3.59 +/- 0.84 EDV/S) and Group 2 (3.61 +/- 0.91 EDV/S) (p < .05).
- A considerable overlap in PFR values was observed between the normal coronary artery group and the LAD disease group.
- Diastolic filling (DF) can be normal in coronary disease (CD) patients with normal left ventricular systolic function (NLVF) if significant LAD disease is absent.
Conclusions:
- Significant left anterior descending artery (LAD) obstruction is associated with abnormal diastolic filling (DF) in patients with normal left ventricular systolic function (NLVF).
- However, the observed DF abnormalities in LAD patients lack predictive value.
- DF may remain normal in coronary disease (CD) patients with normal left ventricular systolic function (NLVF) in the absence of significant LAD disease.
Abstract:
Reduced left ventricular diastolic filling (DF) has been noted in coronary disease (CD) patients with normal left ventricular systolic function (NLVF). However, previous studies have included patients with regional wall disease, hypertension, or left ventricular hypertrophy. In the absence of these factors, only a subgroup of patients who had greater than 75% luminal obstruction of the left anterior descending artery (LAD) demonstrated DF abnormalities. Using 60 frames/sec biplane contrast ventriculography, we evaluated the left ventricular filling curve and its derivative in 21 patients with normal coronary arteries and NLVF (group 1), 17 CD patients with NLVF and no LAD disease (group 2), and 18 patients with LAD disease and NLVF (group 3). The peak filling rate (PFR) as end diastolic volumes/sec (EDV/S) was reduced in group 3 patients (group 3: 3.00 +/- 0.51 EDV/S vs group 1: 3.59 +/- 0.84 EDV/S, p less than .05; and group 2: 3.61 +/- 0.91 EDV/S, p less than .05). There was marked overlap in the PFR's between the normal and LAD group. DF may be normal in CD patients with NLVF in the absence of LAD disease. LAD patients have abnormal DF, but these abnormalities lack predictive valve.