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Digital angiography in assessment of ventricular function and wall motion during pacing in patients with coronary
Insights
Atrial pacing during cardiac catheterization effectively assesses coronary artery disease (CAD) severity. Patients with CAD showed reduced ejection fraction and abnormal wall motion, unlike those with normal arteries.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Interventional Cardiology
Background:
- Coronary artery lesions (CAD) significantly impact cardiac function.
- Assessing the functional severity of CAD is crucial for patient management.
Purpose of the Study:
- To evaluate the utility of atrial pacing during digital subtraction angiography for functional assessment of coronary arterial lesions.
- To differentiate cardiac response in patients with and without significant CAD.
Main Methods:
- Digital subtraction angiography was used to obtain left ventriculograms at rest and during atrial pacing in 21 patients.
- Patients were categorized based on the presence (n=15) or absence (n=6) of significant coronary artery lesions.
- Ejection fraction, end-systolic volume, and wall motion abnormalities were analyzed.
Main Results:
- Patients with significant CAD showed a decreased ejection fraction (62% to 51%, p<0.001) and abnormal wall motion during pacing.
- Patients with normal coronary arteries exhibited an increased ejection fraction (66% to 72%, p<0.01) during pacing.
- Abnormal end-systolic volume responses were observed in patients with CAD compared to those with normal arteries.
Conclusions:
- Atrial pacing combined with digital subtraction angiography provides a functional assessment of coronary artery stenosis severity.
- This method can reveal inducible ischemic changes and assess the impact of CAD on left ventricular function.
- Digital subtraction angiography facilitates serial assessments during routine cardiac catheterization for intervention studies.
Abstract:
Using digital subtraction angiography, left ventriculograms were obtained with 10 ml of iodinated contrast material in 21 patients both at rest and during atrial pacing. In 15 patients with significant coronary artery lesions (CAD) (greater than 50% diameter narrowing in at least 1 major artery), ejection fraction decreased during atrial pacing from a mean of 62 +/- 14% to 51 +/- 15% (p less than 0.001). In 14 (93%) of 15 patients, ejection fraction decreased or was unchanged during pacing. In 6 patients with chest pain but normal coronary arteries, ejection fraction increased from a mean of 66 +/- 9% at rest to 72 +/- 6% during atrial pacing (p less than 0.01). Ejection fraction increased by greater than or equal to 5% during pacing in 5 of 6 patients with normal coronary arteries. Patients with CAD also had an abnormal response in end-systolic volume during atrial pacing (50 +/- 31 ml at rest versus 47 +/- 24 ml during pacing) compared with patients with normal coronary arteries (46 +/- 16 ml at rest versus 26 +/- 9 ml during pacing; p less than 0.01). The digital ventriculograms demonstrated new or increased wall motion abnormalities during atrial pacing in 4 of 5 patients with CAD who had wall motion abnormalities at rest and in 8 of 10 patients with CAD who had normal wall motion at rest. Moreover, these wall motion abnormalities occurred in myocardial wall segments that were supplied by coronary arteries with significant lesions. Thus, because digital subtraction angiography allows multiple left ventriculograms to be obtained during routine cardiac catheterization, intervention studies such as atrial pacing can be used to obtain a functional assessment of the severity of coronary arterial lesions.