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[Left ventricular function and state of the coronary tree in patients with significant coronary lesions (author's
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Prognosis for ischemic heart disease depends on vessel state and heart function. Advanced atherosclerosis impairs the coronary artery tree, impacting treatment options for many patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Prognosis in ischemic cardiopathy is determined by affected vessels, distal coronary tree status, and left ventricular function.
- Coronary artery disease (CAD) significantly impacts patient outcomes and treatment strategies.
Purpose of the Study:
- To analyze coronary angiographic and ventriculographic findings in patients with significant coronary lesions.
- To assess the suitability of patients for coronary bypass surgery based on anatomical and functional criteria.
Main Methods:
- Review of coronary arteriographies and ventriculographies from 274 consecutive patients (1975-1978).
- Evaluation of the number of obstructed coronary vessels, specific artery involvement, and distal coronary tree suitability for bypass grafting.
- Assessment of left ventricular ejection fraction.
Main Results:
- Single-vessel obstruction in 36.5%, two-vessel in 28.5%, and three-vessel in 29.9% of patients.
- Anterior descending coronary artery affected in 78%; distal tree suitability for bypass varied significantly by artery (10-51%).
- 43% of patients were unsuitable for bypass surgery; 22% had ejection fraction <0.40, and 12% had ejection fraction <0.30.
Conclusions:
- Advanced atherosclerosis significantly impairs the distal coronary tree, limiting revascularization options.
- Patient selection for coronary bypass surgery requires comprehensive assessment of coronary anatomy and left ventricular function.
- Coronary angiography and ventriculography are crucial for determining prognosis and guiding treatment in ischemic cardiopathy.
Abstract:
The prognosis of patients with ischemic cardiopathy is mainly based upon the number of affected vesssels, the state of the distal coronary tree, and the left ventricular function. Coronary arteriographies and ventriculographies corresponding to 274 consecutive patients (January, 1975-October, 1978) with significant coronary lesions are reviewed. A singles vessel obstruction was registered in 36.5 percent of the patients; obstruction of two vessels was present in 28.5 percent, and of three vessels in 29.9 percent. The common left trunk was obstructed in 5.1 percent of the cases. The anterior descending coronary artery was affected in 78 percent of the patients, and the left coronary artery, circumflex, first marginal branch, and first diagonal branch showed narrowing in 62, 34, 36, and 26 percent, respectively. The distal tree of the above mentioned arteries was appropriate for coronary bypass operations in 51, 49, 50, 38, and 10 percent of the arteries, respectively. On the basis of coronary angiographic and ventriculographic criteria 117 patients (43 percent) were not candidates to coronary bypass surgery. The ejection fraction was less than 0.40 in 22 percent of the cases, and below to 0.30 in 12 percent (34 patients). The outstanding finding in the present series was the impairment of the distal coronary tree due to advanced atherosclerosis.