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[A clinicopathological study of cor pulmonale with coronary heart disease]
Insights
Coronary heart disease (CHD) complicates cor pulmonale, but heart structure differences are minimal. Diagnostic methods for both conditions lack specificity, highlighting the need for coronary arteriography for accurate CHD diagnosis.
Area of Science:
- Cardiology
- Pulmonology
- Pathology
Background:
- Cor pulmonale, a condition affecting the right side of the heart due to lung disease, can coexist with coronary heart disease (CHD).
- Understanding the interplay and diagnostic challenges of these coexisting conditions is crucial for patient management.
Purpose of the Study:
- To compare necropsy findings in patients with cor pulmonale and concomitant CHD versus those with cor pulmonale alone.
- To evaluate the diagnostic accuracy of various clinical and electrocardiographic factors for cor pulmonale and CHD.
- To identify reliable diagnostic criteria for cor pulmonale with CHD.
Main Methods:
- Necropsy findings from 18 patients with cor pulmonale and CHD were compared to 30 patients with cor pulmonale alone.
- Statistical analysis of heart weight and ventricular thickness.
- Analysis of diagnostic factors including patient history, physical examination findings, electrocardiographic abnormalities, and specific diagnostic criteria.
Main Results:
- No significant differences in average heart weight or ventricular thickness were observed between the groups.
- Diagnostic accuracy for cor pulmonale and CHD was suboptimal, with significant rates of missed diagnoses for both conditions.
- Factors like age, hypertension history, angina, myocardial infarction history, specific physical signs, and electrocardiographic criteria showed statistical significance in diagnosis.
- History of angina pectoris, Selvester MI screening criteria, and Cheng Xiansheng diagnostic criteria emerged as independent prognostic factors.
Conclusions:
- Left ventricular involvement may occur in end-stage cor pulmonale, irrespective of complicating left ventricular disease.
- Current diagnostic methods for cor pulmonale with CHD lack specificity.
- Coronary arteriography remains the gold standard for diagnosing coronary heart disease.
Abstract:
The necropsy findings of 18 patients with cor pulmonale and coronary heart disease (CHD) were compared with those of a control group of 30 patients with cor pulmonale alone. The results showed that there was no significant statistical difference between the two groups on average heart weight and average left and right ventricular thickness (P > 0.05). The results suggest that at the end stage of cor pulmonale left ventricule may be involved whether there are complicating left ventricular disease or not. In this study, cor pulmonale and CHD were both accurately diagnosed in 33.3%, CHD failed to be diagnosed in 38.9% and cor pulmonale failed to be diagnosed in 27.8% of the patients. Single diagnostic factor analysis for cor pulmonale with CHD indicated that age, history of hypertension, history of angina pectoris, history of MI, accentuation A2, presence of bundle branch block, abnormal Q wave and left axis or normal deviation, Cheng Xiansheng diagostic criteria and Selvester MI screening criteria are of significance (P < 0.05). Multiple factor logistic regression analysis indicated that independent prognostic factors including history of angina pectoris, Selvester MI screening criteria and Cheng Xiansheng diagnostic criteria are of help for diagnosis (P < 0.03-0.000). The above-mentioned diagnostic methods are, however, not so specific. At present the best method for diagnosis of CHD is coronary arteriography.