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Left ventricular wall motion at rest in patients with organic coronary artery disease vs coronary spasm
Insights
Patients with organic coronary artery disease show impaired left ventricular wall motion, unlike those with coronary artery spasm, despite similar angina symptoms. This suggests chronic ischemia from stenosed vessels causes ventricular dysfunction in coronary artery disease.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Left ventricular (LV) function is crucial for cardiac health.
- Distinguishing between organic coronary artery disease and coronary artery spasm is vital for understanding their respective impacts on LV function.
Purpose of the Study:
- To compare left ventricular ejection fractions and regional wall motion in patients with organic left anterior descending coronary artery disease versus those with left anterior descending coronary artery spasm.
- To investigate the effects of chronic ischemia versus vasospasm on left ventricular function.
Main Methods:
- Analysis of left ventriculograms at rest to assess ejection fractions and regional ejection changes.
- Comparison of three groups: normal subjects, patients with organic coronary artery disease, and patients with coronary artery spasm.
- Statistical analysis to determine significant differences between groups.
Main Results:
- No significant differences in overall ejection fraction were found among the three groups.
- Patients with organic coronary artery disease exhibited significantly decreased regional ejection changes in the anterolateral and apical walls compared to normal subjects.
- Patients with coronary artery spasm showed no impairment in anterolateral and apical wall motion.
Conclusions:
- Organic coronary artery disease leads to impaired left ventricular wall motion, likely due to chronic ischemia from stenosed vessels.
- Coronary artery spasm, even with angina symptoms, does not appear to cause significant left ventricular wall motion abnormalities.
- LV regional wall motion analysis is a sensitive indicator for differentiating the functional impact of organic coronary artery disease from coronary artery spasm.
Abstract:
Left ventricular ejection fractions and regional ejection changes obtained from left ventriculograms at rest were analyzed in 15 normal subjects, in 17 patients with isolated, organic left anterior descending coronary artery disease, and in 11 patients with isolated left anterior descending coronary artery spasm. Patients with coronary artery spasm did not have significant organic lesions at the site of spasm. All patients with organic coronary artery disease and coronary artery spasm had a history of angina pectoris without myocardial infarction. No significant differences in ejection fraction were observed among the three groups. The regional ejection change of the anterolateral and apical wall supplied by the left anterior descending coronary artery was significantly decreased in patients with organic coronary artery disease compared with those in normal subjects (anterolateral 39.5 +/- 10.3% vs 48.4 +/- 7.7%, p less than 0.05; apical 48.4 +/- 8.8% vs 55.6 +/- 7.8%, p less than 0.05). However, the anterolateral and apical wall motion was not impaired in patients with coronary artery spasm. Thus, patients with organic coronary artery disease had impairment of left ventricular wall motion, while those with coronary artery spasm did not, although both groups of patients had symptoms of angina. These results suggest that patients with organic coronary artery disease may have had coronary blood flow disturbances through stenosed vessels and chronic active ischemia that produced left ventricular impairment.