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Impaired regional diastolic distensibility in coronary artery disease: relations with dynamic left ventricular
Insights
Patients with angina pectoris often have impaired regional left ventricular distensibility, affecting chamber compliance. This occurs even without clinical signs of ischemia, impacting diastolic function and filling pressures.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Left ventricular (LV) distensibility and chamber compliance are crucial for diastolic function.
- Coronary artery disease (CAD) can impact LV mechanics, but regional alterations are not fully understood.
Purpose of the Study:
- To investigate regional left ventricular distensibility and its relationship with dynamic LV chamber compliance in patients with CAD.
- To assess the prevalence of regional abnormalities in LV filling in patients with angina pectoris.
Main Methods:
- Regional peak filling rates (PFR) were calculated from angiographic data in eight LV segments as an index of regional distensibility.
- Compared PFR and LV filling pressures between normal subjects and patients with angina pectoris.
- Evaluated the effect of nicardipine on regional PFR and LV filling pressures in a subgroup of patients.
Main Results:
- Regional PFR abnormalities were detected in 75% of angina patients, compared to only 30% with depressed global PFR.
- Patients with reduced regional PFR had significantly increased mean LV filling pressures.
- Nicardipine improved regional PFR, reduced LV filling pressure, and shifted the LV pressure-volume relation favorably.
Conclusions:
- Impaired regional left ventricular distensibility is common in angina pectoris patients, even without overt ischemia or infarction.
- Regional distensibility abnormalities are closely related to impaired LV diastolic function and altered chamber compliance.
- These findings highlight the importance of assessing regional LV mechanics in managing patients with CAD.
Abstract:
The regional left ventricular distensibility and its relations with the dynamic left ventricular chamber compliance were studied in 11 normal subjects and in 30 patients with coronary artery disease. The regional peak filling rates were calculated from angiographic data in eight ventricular segments and used as an index of regional distensibility. A depressed global peak filling rate was observed in only 30% of the patients with angina pectoris, but regional abnormalities in peak filling rate were detected in 75% of these patients. A relation between alterations in regional peak filling rate and left ventricular compliance was evident in these patients. Despite comparable end diastolic volume and pressure (10 +/- 2 mm Hg vs. 10 +/- 3 in normal subjects; not significant), the patients with angina pectoris, whose ventricle had at least three segments with a reduced peak filling rate, had indeed significant increases in mean left ventricular filling pressure (14 +/- 4 mm Hg vs. 8 +/- 3 in normal subjects; p less than 0.01) and upward shifts of their left ventricular pressure-volume relation during rapid filling. Conversely, an increase in regional peak filling rate produced by intravenous administration of the calcium antagonist nicardipine in a subgroup of patients with poor diastolic function was accompanied by a reduction in mean left ventricular filling pressure and by a downward shift of the early diastolic left ventricular pressure-volume relation. It is concluded that even in the absence of clinical signs of ischemia and of a previous myocardial infarction, large areas with impaired distensibility are frequently present in patients with angina pectoris.(ABSTRACT TRUNCATED AT 250 WORDS)