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Asynchronous left ventricular wall motion in unstable angina
M Y Henein1, D J Patel, K M Fox
1Cardiac Department, Royal Brompton Hospital, London, UK.
Insights
Unstable angina patients exhibit more severe left ventricular wall motion abnormalities than chronic stable angina patients, linked to coronary artery disease severity. These findings suggest a connection between wall motion issues and angina instability.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Left ventricular (LV) wall motion disturbances are key indicators in coronary artery disease (CAD).
- Understanding the specific nature of these disturbances in unstable angina (UA) versus chronic stable angina (CSA) is crucial for diagnosis and management.
- The interplay between symptom severity and CAD extent in causing these abnormalities requires further elucidation.
Purpose of the Study:
- To characterize left ventricular wall motion disturbances in unstable angina patients.
- To determine the influence of symptom severity and coronary artery disease extent on these abnormalities.
- To compare findings in unstable angina with chronic stable angina and normal controls.
Main Methods:
- Prospective study involving 30 unstable angina patients (triple CAD), 34 chronic stable angina patients (triple CAD or isolated LAD disease), and 21 normal controls.
- Assessment of left ventricular cavity size and long axis shortening during isovolumic relaxation time (IVRT).
- Evaluation of other long axis motion parameters and transmitral E/A ratio.
Main Results:
- Patients with unstable angina showed significantly more marked and widespread (>3 mm) abnormal long axis shortening during IVRT (65% of LV sites) compared to chronic stable angina patients (minor <3 mm, 12% of LV sites).
- Minor long axis abnormalities during IVRT were similar in CSA and UA and correlated with CAD severity.
- Transmitral E/A ratio was reduced in both UA and CSA with triple vessel disease.
Conclusions:
- Abnormal left ventricular shortening during IVRT is more severe and generalized in unstable angina.
- The incidence of minor long axis abnormalities is comparable in chronic stable and unstable angina and is related to coronary artery disease severity.
- These wall motion abnormalities are closely associated with the development of instability in the context of coronary artery disease.
Abstract:
The objective of the study was to assess the nature of left ventricular wall motion disturbances in patients with unstable angina and the relative contributions of the severity of symptoms and the severity of coronary artery disease (CAD) to their genesis. A prospective examination was performed on 30 patients with unstable angina (UA) with triple CAD, 34 matched patients with chronic stable angina (CSA) (20 with triple CAD and 14 with isolated left anterior descending (LAD) artery disease), and compared to 21 normals. LV cavity size was normal in all three groups. Twenty-two of 30 patients with UA had marked (>3 mm) abnormal long axis shortening during isovolumic relaxation time (IVRT), 65% of LV sites being abnormal. In CSA, minor (<3 mm) shortening during IVRT occurred in 7 patients with triple CAD, and in 5 with LAD disease, with 12% of LV sites involved in both groups, P<0.001 vs. UA. The incidence of other long axis abnormalities, including reduced extent and peak rate of shortening and lengthening as well as the delay in the onset of shortening and lengthening was increased between patients with CSA and triple CAD compared with LAD but not between the two groups of patients with triple CAD, CSA and UA. Transmitral E/A ratio was also reduced in the two groups with triple vessel disease, CSA and UA. Thus, the incidence of minor long axis abnormalities is similar in CSA and UA and is related to the severity of CAD. However, abnormal shortening during IVRT is more severe and generalised in UA but not in CSA with triple vessel disease. We suggest that these abnormalities of wall motion bear a close relation to the development of instability within the setting of CAD.