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[So-called coronary angiographic paradoxes]
Insights
Microcirculatory disorders in coronary arteries correlate with electrocardiography results and left ventricular damage in heart disease patients. Even normal arteriograms require further investigation for myocardial blood supply and function issues.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Ischemic heart disease (IHD) diagnosis often relies on coronary arteriography, but microcirculatory dysfunction can occur even with normal arteriograms.
- Assessing myocardial microcirculation is crucial for understanding heart disease progression and left ventricular function.
Purpose of the Study:
- To investigate the correlation between coronary artery microcirculatory disorders and left ventricular myocardial changes.
- To evaluate the sensitivity of various left ventricular function indices in relation to microcirculatory status.
Main Methods:
- Studied 25 patients (18 with IHD, 7 with cardialgia) using intraarterial injection of radiolabeled albumin aggregates to assess coronary arteriolar-capillary beds.
- Determined integral function (ejection fraction [EF], Vcf, MNSER) and regional contractility (% delta r, L) in 14 patients.
- Correlated microcirculatory findings with electrocardiography (ECG) results and left ventricular structural/functional parameters.
Main Results:
- A correlation was found between the degree of microcirculatory disorders and ECG findings.
- Increased microcirculatory impairment was associated with more frequent cicatricial changes, myocardial infarction history, and left ventricular aneurysm.
- Vcf, MNSER, and % delta r, L were the most sensitive indicators of left ventricular function related to microcirculation, showing regional hypo/hyperkinesia and paradoxical pulsation.
Conclusions:
- Normal coronary arteriograms do not rule out ischemic heart disease or other primary myocardial diseases.
- Microcirculatory disorders significantly impact left ventricular function and structure, necessitating thorough patient evaluation.
- Further investigation of myocardial blood supply and left ventricular function is essential in patients with suspected heart disease, even with normal arteriograms.
Abstract:
The results of examination of 25 patients (18 with ischemic heart disease and 7 with cardialgia of other etiology) are discussed. The arteriolo-capillary bed of the coronary arteries was studied by intraarterial injection of albumin aggregates labelled with radioactive isotopes. A correlation was revealed between the degree of microcirculatory disorders and the results of electrocardiography. With increase in the degree of microcirculatory disorders, cicatricial changes in the left ventricular myocardium were found more frequently and a history of myocardial infarction (in 11 persons) and the development of left ventricular aneurysm (in 2 patients) were noted. Certain indices of integral function (EF, VcF, MNSER) and regional contractility (% delta r, L) of the left ventricle were determined in 14 patients. Among these parameters characterizing left ventricular function (EF, VCF, MNSER, % delta r, L), VCF, MNSER, and % delta r, L are most sensitive. No correlation was revealed between the state of the myocardial microcirculation bed and EF, VCF, and MNSER, but a definite correlation was found between it and % delta r, L (in the form of regional hypo- and hyperkinesia and paradoxical pulsation). Normal coronary arteriograms do not exclude the presence of ischemic heart disease and other primary diseases of the myocardium. Patients of this category should be examined more scrupulously to detect disorders of blood supply to the myocardium and function of the left ventricle.