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Detection of diastolic left ventricular function abnormalities in patients with coronary artery disease and normal
Insights
Patients with coronary artery disease show altered left ventricular (LV) filling patterns, even with normal systolic function. This indicates unique diastolic filling characteristics in coronary artery disease patients.
Area of Science:
- Cardiology
- Physiology
Background:
- Left ventricular (LV) filling is crucial for cardiac function.
- Coronary artery disease (CAD) can affect diastolic function.
- Assessing LV filling patterns in CAD patients with preserved systolic function is important.
Purpose of the Study:
- To investigate and compare left ventricular (LV) diastolic filling patterns between patients with and without coronary artery disease (CAD), despite normal systolic function.
- To identify specific differences in filling fractions during diastole.
Main Methods:
- Angiographic calculation of LV volumes at end systole (ESV) and throughout diastole (DV 1/3, DV 1/2, DV 2/3, EDV).
- Calculation of filling fractions (FF 1/3, FF 1/2, FF 2/3, FF 3/3) to quantify diastolic filling.
- Comparison of these parameters between a cohort of 50 patients with normal systolic function, including 21 with CAD.
Main Results:
- Patients with CAD exhibited significantly lower filling fractions in the early diastolic phases (FF 1/3: 23.8% vs. 37.4%, p<0.002; FF 1/2: 45.3% vs. 58.6%, p<0.005).
- Conversely, CAD patients showed a trend towards higher filling fractions in the late diastolic phase (FF 3/3: 37.2% vs. 28.8%, p<0.02).
- No significant difference was observed in the mid-diastolic filling fraction (FF 2/3).
Conclusions:
- Left ventricular (LV) filling occurs differently in patients with coronary artery disease (CAD) compared to those without, even when systolic function is normal.
- CAD alters the temporal distribution of diastolic filling, suggesting impaired early diastolic relaxation or increased diastolic stiffness.
Abstract:
We angiographically calculated left ventricular (LV) filling in 50 patients, all of whom had normal systolic LV function and 21 (42%) of whom had coronary systolic LV function and 21 (42%) of whom had coronary artery disease. Five volume determinations were made: at end systole (ESV), first third (DV 1/3, half (DV 1/2), and second third of diastole (DV 2/3), and at the end of diastole (EDV). To assess different modalities of filling, we calculated filling fractions in the first third (FF 1/3) as the ratio of volume filled in the first third diastole (DV 1/3-ESV) over total diastolic filling (EDV-ESV). Similar filling fractions (FF) were calculated at half (FF 1/2), second third (FF 2/3), and last third (FF 3/3) of diastole. We found significant differences between normal and coronary artery disease patients as follows: FF 1/3: 37.4 +/- 14.9 versus 23.8 +/- 11.9%, respectively (p less than 0.002); FF 1/2: 58.6 +/- 14.7 versus 45.3 +/- 15.1% (p less than 0.005); FF 2/3: 33.8 +/- 15.2 versus 39.0 +/- 10.4% (NS), and differences in the opposite direction in the FF 3/3: 28.8 +/- 15.2 versus 37.2 +/- 11.9% (p less than 0.02), respectively. We conclude that LV filling is accomplished differently in patients with coronary artery disease even if they have normal systolic function.