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Effects of antecedent anginal episodes and coronary artery stenosis on left ventricular function during coronary
K Nishigami1, M Ando, K Hayasaki
1Division of Cardiology, Saiseikai Kumamoto Hospital, School of Medicine, Kumamoto University, Japan.
Insights
Patients with frequent angina episodes and severe coronary artery stenosis show less left ventricular dysfunction during coronary occlusion, likely due to enhanced collateral circulation development.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Angina pectoris is often associated with coronary artery disease.
- Left ventricular function during ischemia is critical for patient outcomes.
- Collateral circulation may protect the myocardium during coronary occlusion.
Purpose of the Study:
- To investigate the impact of antecedent anginal episodes and coronary stenosis severity on left ventricular function during coronary occlusion.
- To determine the role of collateral filling in mitigating left ventricular dysfunction in patients with angina pectoris.
Main Methods:
- Echocardiography was used to assess left ventricular wall motion abnormalities (hypokinesia, akinesia).
- Coronary artery stenosis severity was quantified.
- Collateral filling was evaluated using a second artery catheter during angioplasty in 33 patients.
Main Results:
- A higher frequency of antecedent anginal episodes correlated with reduced akinesia (p < 0.01).
- More severe coronary artery stenosis was associated with less left ventricular dysfunction (p < 0.05).
- Patients with grade 3 collateral filling showed no akinesia, unlike those with lower grades (p < 0.01).
Conclusions:
- Frequent angina episodes and severe coronary stenosis may indicate better myocardial protection during ischemia.
- Extensive collateral development appears to be a key factor in preserving left ventricular function under coronary occlusion.
Abstract:
We evaluated the effects of antecedent anginal episodes and coronary artery stenosis on left ventricular function during coronary occlusion and the role of collateral filling in 33 patients with angina pectoris who underwent angioplasty. Wall motion abnormalities were investigated by echocardiography and classified into hypokinesia and akinesia. Collateral filling during angioplasty was evaluated by using a second artery catheter. Akinesia was observed as follows: 24% of the patients had > 30 anginal episodes, 38% had 5 to 30, and 87% of the patients had < 5 (p < 0.01); 12% of patients had a lesion of 99%, 47% had a lesion of 90%, and 83% had a lesion of 75% (p < 0.05). Akinesia was observed in none of the patients with grade 3 collaterals, 57% with grade 2, and 67% with grade 1 or 0 (p < 0.01). These observations suggest that the patients with antecedent frequent anginal episodes and severe coronary stenosis have less left ventricular dysfunction during coronary occlusion. This finding may be the result of more extensive collateral development.