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[Relations between the site of significant monotruncular coronary stenosis and left ventricular function. Therapeutic
Insights
Coronary artery disease affecting the left anterior descending artery significantly impairs left ventricular function, especially after myocardial infarction. Stenosis in the right coronary artery has a less pronounced effect on heart function.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- The clinical utility of coronary bypass surgery for single-vessel disease is debated.
- Assessing the extent of at-risk myocardium is crucial for treatment decisions.
Purpose of the Study:
- To evaluate the quantity of myocardium at risk in patients with single-vessel disease.
- To compare hemodynamic parameters in relation to stenosis location and myocardial infarction.
Main Methods:
- Retrospective analysis of coronary angiograms and left ventriculography in 93 patients.
- Inclusion criteria: >70% stenosis in the left anterior descending (LAD) or dominant right coronary artery (RCA).
- Comparison of five angio-hemodynamic parameters: ejection fraction (EF), LVESP/LVESV, VCF, EDV, and ESV.
Main Results:
- Left ventricular function was preserved in the absence of myocardial infarction (MI).
- Significant deterioration of left ventricular function (EF, LVESP/LVESV, VCF) was observed with LAD stenosis, particularly when associated with MI.
- Minimal changes in left ventricular function were noted in patients with RCA stenosis and previous necrosis.
Conclusions:
- Left anterior descending (LAD) artery stenosis, especially with myocardial infarction (MI), leads to substantial left ventricular dysfunction.
- Right coronary artery (RCA) stenosis with prior MI has a less detrimental impact on left ventricular hemodynamics compared to LAD disease.
Abstract:
The indications of coronary bypass surgery in single vessel disease remain controversial. Therefore, we carried out a retrospective study of the coronary angiogrammes and left ventriculography of 93 patients with single vessel disease (greater than 70 p. 100 stenosis) involving the left anterior descending (LAD) or dominant right coronary arteries (RCA) to evaluate the quantity of myocardium at risk. Five angio-hemodynamic parameters were compared: the ejection fraction (EF), the ratio of end systolic left ventricular pressure to volume (LVESP/LVESV), the velocity of circumferential fibre shortening (VCF), end diastolic volume (EDV) and end systolic volume (ESV). Six subgroups were defined: 28 proximal LAD stenosis (16 without and 12 with myocardial infarction (MI], 37 mid LAD stenosis (20 without and 17 with MI), and 28 RCA stenosis (8 without and 20 with MI). In all, there were 44 single vessel stenoses without MI and 49 with previous necrosis. Left ventricular function was normal in the absence of MI but deteriorated progressively in cases with MI and LAD disease. In cases of proximal LAD stenosis without and with MI, the hemodynamics showed: EF (p. 100) = 67,12 +/- 2,07 leads to 43,83 +/- 4,7 (p less than 0,001); LVESP/LVESV = 3,24 +/- 0,34 leads to 1,92 +/- 0,50 (p less than 0,05); VCF (s-1) = 1,28 +/- 0,05 leads to 0,74 +/- 0,06 (p less than 0,001); in cases of mid LAD stenosis without and with MI: EF = 69,1 +/- 2,08 leads to 45,11 +/- 3,42 (p less than 0,001); LVESP/LVESV = 3,64 +/- 0,39 leads to 1,46 +/- 0,12 (p less than 0,001); VCF = 1,32 +/- 0,008 leads to 0,74 +/- 0,06 (p less than 0,001). In contrast the change in LV function was minimal in patients with necrosis and RCA stenosis: EF = 70,37 +/- 3,85 leads to 56,4 +/- 3,19 (p less than 0,05); LVESP/LVESV = 5,20 +/- 1,83 leads to 2,56 +/- 0,36 (p less than 0,05); VCF less than 1,42 +/- 0,17 leads to 1,03 +/- 0,08 (p less than 0,05).(ABSTRACT TRUNCATED AT 400 WORDS)