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Exercise induced ventricular arrhythmias. Angiographic correlation with the severity of coronary artery disease
Insights
Exercise induced ventricular arrhythmias (EIVA) in coronary artery disease (CAD) patients are more strongly linked to left ventricular (LV) wall motion abnormalities than to the number of blocked arteries or prior myocardial infarction.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) is a leading cause of morbidity and mortality.
- Exercise-induced ventricular arrhythmias (EIVA) are a potential complication in CAD patients.
- The relationship between CAD severity and EIVA requires further elucidation.
Purpose of the Study:
- To correlate the incidence and severity of EIVA with angiographic CAD characteristics.
- To assess the predictive value of left ventricular (LV) function and prior myocardial infarction (MI) on EIVA.
Main Methods:
- 162 patients with stable effort angina and significant coronary stenosis underwent correlation analysis.
- Patients were categorized by old transmural MI, number of stenoses, and LV segmental wall motion abnormalities (ASWM).
- EIVA incidence was compared across different CAD severity and LV dysfunction groups.
Main Results:
- EIVA incidence was higher in multivessel CAD but not statistically significant.
- The number of LV areas with ASWM strongly correlated with EIVA frequency (p < 0.001).
- Patients with old MI had higher EIVA, but this was attributed to more severe LV asynergy.
Conclusions:
- LV segmental wall motion abnormalities are a better predictor of EIVA than the number of diseased coronary arteries.
- The extent of LV dysfunction is a critical factor in the development of EIVA in CAD patients.
- Risk stratification for EIVA should consider LV functional status in addition to CAD severity.
Abstract:
We correlated the incidence and degree of exercise induced ventricular arrhythmias (EIVA) with the angiographic severity of coronary artery disease (CAD) in 162 patients with a history of stable effort angina, all showing a positive exercise stress test for myocardial ischemia and a greater than or equal to 70% stenosis of a major coronary artery. Patients were grouped according to the following criteria: presence of electrocardiographic evidence of old transmural myocardial infarction (MI), number of significant coronary stenoses and number of left ventricular (LV) areas showing abnormal segmental wall motion (ASWM). The incidence of EIVA in patients with multivessel CAD was higher than in patients with single vessel CAD, but this difference was not statistically significant. The number of LV areas with ASWM was better correlated with the frequency of EIVA, which was 20.0% in patients with normal LV wall motion, 31.2% in patients with 1 area of ASWM, 54.0% in patients with 2 areas of ASWM (p less than 0.005 vs normal LV wall motion), 74.1% in patients with 3 or more areas of ASWM (p less than 0.001 vs normal LV wall motion and 1 area of ASWM), and 81.8% in patients with LV aneurysm (p less than 0.001 vs normal LV wall motion and 1 area of ASWM, p less than 0.005 vs 2 areas of ASWM). Patients with old MI showed a significantly higher incidence of EIVA than those without MI (p less than 0.001), but this difference was due to the more severe LV asynergy in the MI group. In conclusion, our results show that, in a selected population of patients with CAD, the incidence of EIVA correlates better with the extent of LV segmental wall motion abnormalities than with the number of diseased coronary arteries or the presence of an old transmural MI.