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Diagnosis of coronary artery disease by estimation of coronary sinus lactate
Insights
Coronary sinus lactate estimation during atrial pacing helps diagnose coronary artery disease. Changes in lactate levels effectively differentiate normal coronary arteries from significant blockages.
Area of Science:
- Cardiology
- Diagnostic Medicine
Background:
- Obstructive coronary artery disease (CAD) diagnosis relies on invasive procedures.
- Non-invasive or less invasive diagnostic markers for CAD are needed.
Purpose of the Study:
- To evaluate coronary sinus lactate estimation during atrial pacing as a diagnostic tool for obstructive coronary artery disease.
- To correlate lactate changes with the severity of coronary artery disease.
Main Methods:
- Seventy patients with angina underwent coronary sinus lactate estimation before and during atrial pacing.
- Selective coronary arteriography was performed for comparison.
- Coronary arteriovenous lactate difference was analyzed.
Main Results:
- A change in lactate difference < 0.09 mmol/l indicated normal coronary arteries (except one case).
- A change > 0.22 mmol/l consistently indicated coronary artery disease.
- A change > 0.39 mmol/l suggested disease in two or three vessels.
- Results were inconclusive for lactate changes between 0.09 and 0.22 mmol/l.
Conclusions:
- Coronary sinus lactate estimation before and during atrial pacing can frequently distinguish patients with normal coronary arteries from those with CAD.
- The method shows promise for non-invasively assessing coronary artery health.
Abstract:
In an attempt to assess the value of coronary sinus lactate estimation before and during atrial pacing for the diagnosis of obstructive coronary artery disease, 70 patients with angina were investigated in this way and by selective coronary arteriography. Thirty-five had radiologically normal coronary arteries and 35 had coronary artery disease. When the change in coronary arteriovenous lactate difference was less than 0.09 mmol/l (0.8 mg/100 ml) between the control and the peak atrial pacing sample, the coronary arteries were normal except in one patient who had distal disease of a single vessel. When the change was greater than 0.22 mmol/l (2.0 mg/100 ml) coronary artery disease was always found, and when the change was greater than 0.39 mmol/l (3.5 mg/100 ml) there was always disease of two or three vessels. Unfortunately, the presence or absence of coronary artery disease could not be predicted when the change fell between 0.09 and 0.22 mmol/l (0.8 and 2.0 mg/100 ml). Estimation of coronary sinus lactate before and during atrial pacing can thus frequently distinguish patients with normal coronary arteries from those with coronary artery disease.