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Alterations in left ventricular shape in patients with angina and single-vessel coronary disease
F Fantini1, G Barletta, M Di Donato
1Department of Internal Medicine, University of Florence, Italy.
Insights
Patients with angina but no heart attack history experience altered left ventricular shape, even in areas not affected by reduced blood flow. These changes in heart muscle shape are linked to coronary artery disease.
Area of Science:
- Cardiology
- Cardiac Imaging
- Heart Disease Research
Background:
- Left ventricular shape changes occur in stable angina patients, independent of acute ischemia or prior infarction.
- Previous studies in multivessel disease limited anatomical correlation of ischemia and shape changes.
- This study investigates left ventricular shape in single-vessel coronary disease for localized ischemia analysis.
Purpose of the Study:
- To analyze left ventricular shape in patients with angina and single-vessel coronary disease.
- To establish a clearer anatomical relationship between ischemic regions and left ventricular contour changes.
- To extend previous observations on left ventricular shape alterations in angina.
Main Methods:
- Retrospective analysis of 58 angina patients with single-vessel disease, normal function, and no prior infarction.
- Inclusion of patients with critical stenosis in the left anterior descending or right coronary artery.
- Evaluation of global left ventricular shape using eccentricity and circular indices, and regional curvature via windowed Fourier analysis.
Main Results:
- Patients exhibited diastolic alterations in left ventricular shape, appearing more rounded than normal.
- Significant regional curvature changes were observed in anterior, apical, and inferior segments.
- Shape alterations occurred in both potentially ischemic and remote zones, with greater extent in stable angina and left anterior descending artery stenosis.
Conclusions:
- Angina patients without prior myocardial infarction or systolic dysfunction show left ventricular shape abnormalities.
- These abnormalities are present in both ischemic and remote myocardial regions.
- The underlying mechanisms for these shape changes remain speculative.
Background:
Left ventricular shape alterations, apparently independent of acute ischaemia or previous myocardial infarction, have been described in patients with stable angina. Our previous observations had been made in a group of patients with multivessel coronary disease; it was therefore not possible to establish a clear-cut anatomical relationship between the location of ischaemia and the changes in left ventricular contour. The aim of this work was to extend the previous observations by analysing left ventricular shape in patients with angina and single-vessel coronary disease, in whom the potentially ischaemic region can be easily localized.
Methods:
Fifty-eight patients with stable or unstable angina were retrospectively selected if they had single-vessel disease, normal regional and global function and no previous myocardial infarction: 37 had a critical stenosis (more than 75% diameter reduction) of the left anterior descending artery and 21 had a critical stenosis of the right coronary artery. Patients with left ventricular hypertrophy or any other obvious cause of myocardial dysfunction were excluded. All patients underwent haemodynamic study. Left ventricular global shape was evaluated by calculating eccentricity and circular indices; regional curvature was measured at 90 points along the angiographic contours (right anterior oblique projection) by applying a windowed Fourier analysis. Results were compared with those obtained in 16 normal subjects.
Results:
Patients had significant diastolic alterations in left ventricular shape, which assumed a more rounded aspect than normal. Regional curvature was significantly altered at several points pertaining to the anterior, apical and inferior segments. The pattern of changes in regional curvature was about the same in the left anterior descending and right coronary artery groups, with the involvement of regions supplied by angiographically normal arteries, although the extent of alteration was greater in patients with stable, chronic angina (more than 6 months) and in patients with stenosis of the left anterior descending artery.
Conclusions:
Patients with angina, no previous myocardial infarction and normal systolic function had left ventricular shape abnormalities either in the potentially ischaemic or in the remote zones. The mechanism leading to these changes is still speculative.