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Left ventricular filling is usually normal in uncomplicated coronary disease
Insights
Diastolic dysfunction, an early sign in coronary artery disease (CAD) and hypertension (HTN), shows distinct patterns. CAD patients exhibited more severe reductions in peak filling rate compared to HTN patients.
Area of Science:
- Cardiology
- Physiology
Background:
- Left ventricular filling abnormalities are early indicators in coronary artery disease (CAD) and hypertension (HTN).
- Understanding the differences in diastolic dysfunction patterns between CAD and HTN is crucial for diagnosis and management.
Purpose of the Study:
- To compare the prevalence and specific patterns of diastolic dysfunction in patients with CAD and HTN.
- To differentiate diastolic abnormalities in CAD and HTN using key diastolic indices.
Main Methods:
- Studied three groups: normal volunteers (NLS), hypertension (HTN) patients, and coronary artery disease (CAD) patients.
- CAD patients were sub-grouped based on ejection fraction (EF) and history of HTN.
- Assessed diastolic indices: peak filling rate (PFR), time to peak filling rate (TPFR), and first-third filling fraction (FF 1/3).
Main Results:
- Both CAD and HTN groups showed significantly reduced PFR compared to NLS; CAD group had lower PFR than HTN group.
- TPFR was prolonged in HTN but not significantly altered in CAD.
- FF 1/3 was reduced in both groups, with HTN showing a significantly greater reduction than CAD.
Conclusions:
- Diastolic dysfunction presents differently in CAD and HTN, with CAD showing more pronounced PFR reduction.
- While both conditions impair diastolic function, the specific patterns may aid in distinguishing between them.
- Even in CAD patients with preserved systolic function, subtle diastolic changes were observed.
Abstract:
Abnormalities in left ventricular filling have been described as an early finding in coronary artery disease (CAD) and more recently, in hypertension (HTN). The present study was undertaken to compare the prevalence and pattern of diastolic dysfunction in these two entities. Three groups of patients were studied: 10 normal volunteers (NLS), 39 HTN patients, and 30 CAD patients. The CAD patients were divided into two subgroups--one with normal ejection fraction (mean 0.60 +/- 0.06) and the second with either a depressed ejection fraction (EF) or a history of HTN (mean EF 0.44 +/- 0.15). The diastolic indices examined were peak filling rate (PFR, in end-diastolic volume [EDV]/sec), time to peak filling rate (TPFR, in msec), and first-third filling fraction (FF 1/3, in sec-1). The PFR in CAD and HTN was significantly reduced (1.86 +/- 0.63 and 2.29 +/- 0.49 vs 2.70 +/- 0.35 EDV/sec in NLS, p less than 0.025 and p less than 0.001, respectively), with the CAD group also being significantly lower than the HTN group (p less than 0.005). TPFR was prolonged in HTN, but not in CAD. FF 1/3 was reduced in both HTN and CAD (0.38 +/- 0.11 and 0.50 +/- 0.14 vs 0.61 +/- 0.06 sec-1 in NLS, p less than 0.001 and p less than 0.025, respectively), but it was significantly lower in HTN than in CAD (p less than 0.001). However, when the subgroup of CAD patients with normal global systolic function was examined separately, diastolic indices were only slightly depressed. More importantly, only one, two, and five patients had PFR, TPFR, and FF 1/3, respectively, which were below the normal values of our laboratory.