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Left ventricular diastolic filling in patients with coronary artery disease and normal left ventricular function
Insights
Coronary disease (CD) patients with normal left ventricular function often show abnormal diastolic filling (DF). However, significant left anterior descending artery disease can cause abnormal DF even with preserved ejection fraction.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Diastolic Dysfunction
Background:
- Abnormal left ventricular diastolic filling (DF) is observed in coronary disease (CD) patients with normal left ventricular function (NLVF).
- Factors like regional wall disease, hypertension, and left ventricular hypertrophy may contribute to abnormal DF in CD.
- Previous studies suggest NLVF in CD patients may mask underlying diastolic abnormalities.
Purpose of the Study:
- To evaluate left ventricular diastolic filling (DF) patterns in coronary disease (CD) patients with normal left ventricular function (NLVF).
- To compare DF parameters between normal individuals, CD patients with NLVF, and CD patients with regional disease.
- To identify specific characteristics of CD and NLVF associated with abnormal DF.
Main Methods:
- Utilized gated blood pool scans to derive left ventricular diastolic filling (DF) curves.
- Analyzed 21 normal subjects (Group 1), 38 CD patients with NLVF (Group 2), and 28 CD patients with preserved ejection fraction and regional disease (Group 3).
- Quantified peak filling rate (PFR), mean filling rate (MFR), % stroke volume at 1/3 diastole (%SV-1/3 DT), and % stroke volume at rapid filling (%SV-RFP).
Main Results:
- Diastolic filling (DF) parameters were similar between normal subjects (Group 1) and a select group of CD patients with NLVF (Group 2).
- CD patients with NLVF and significant (>=75%) left anterior descending artery (LAD) disease showed reduced %SV-RFP and PFR compared to normals.
- CD patients with regional disease (Group 3) exhibited significantly reduced PFR, MFR, %SV-1/3 DT, and %SV-RFP compared to normals.
Conclusions:
- Diastolic filling (DF) in coronary disease (CD) patients with normal left ventricular function (NLVF) can be similar to normals in specific patient subsets.
- Abnormal DF is evident in CD patients with NLVF when regional disease, particularly significant left anterior descending artery (LAD) obstruction, is present.
- Preserved ejection fraction does not exclude diastolic dysfunction in CD patients with regional wall abnormalities.
Abstract:
Abnormal left ventricular diastolic filling (DF) has been noted in coronary disease (CD) patients with normal left ventricular function (NLVF). Inclusion of patients with regional wall disease, hypertension, and left ventricular hypertrophy may be responsible for abnormal DF. We evaluated left ventricular DF curves derived from gated blood pool scans in 21 normals (group 1), in 38 CD patients with NLVF specifically defined (group 2), and in 28 CD patients with ejection fractions greater than 50% and regional disease (group 3). The peak filling rate (PFR), mean filling rate (MFR), the percentage of stroke volume filled at one third of diastole (%SV-1/3 DT) and at the end of the rapid filling period (%SV-RFP) were determined. Groups 1 and 2 had similar DF parameters. Group 2 patients with 75% obstructive left anterior descending disease (LAD) had a reduced %SV-RFP and PFR (2.56 +/- 0.56 end-diastolic volumes/sec [EDV/S]) as compared to normals (3.11 +/- 0.65 EDV/S, p less than 0.01). Group 3 patients had a reduced PFR (2.14 +/- 0.53 EDV/S, p less than 0.001), MFR, %SV-1/3 DT, and %SV-RFP. DF in CD patients with NLVF was similar to normals in a select group of patients but was abnormal in patients with regional disease and greater than 75% LAD disease with NLVF.