Severe atherosclerotic coronary arterial narrowing and chronic congestive heart failure without myocardial infarction: analysis of 18 patients studied at necropsy.
Observations are reported on 18 patients (aged 38 to 73 years ([mean 58]; 16 [89%] men) studied at necropsy who had had chronic congestive heart failure (CHF) more than 3 months in duration, greater than 75% cross-sectional area (XSA) narrowing of 1 or more of the 4 major epicardial coronary arteries, and no left ventricular fibrosis or necrosis. Duration of symptoms from onset of CHF to death ranged from 0.3 to 13 years (mean 5.7). Angina pectoris occurred in 2 patients (11%). The mode of death was CHF in 12 (67%), sudden (arrhythmia) in 5 (28%), and emboli in 1 (5%). Heart weight ranged from 410 to 890 g (mean 632). Of 72 major epicardial coronary arteries (right, left main, left anterior descending, left circumflex) in the 18 patients, 30 (42%) were narrowed 76 to 100% in XSA by atherosclerotic plaque (right = 10, left main = 0, left anterior descending = 9 and left circumflex = 11). A mean of 1.7 of 4 major epicardial coronary arteries per patient were narrowed 76 to 100% in XSA by atherosclerotic plaque. In 10 patients, each 5-mm segment of the 4 major coronary arteries was examined histologically (mean 53 per patient): 23 segments (3%) were narrowed 96 to 100% in XSA by atherosclerotic plaque; 58 (11%), 76 to 95; 93 (18%), 51 to 75%; 209 (40%), 26 to 50%, and 146 (28%), 0 to 25%. Left and right ventricular thrombi were found in 9 patients (50%); of the 9 patients, 1 had a systemic embolus; of the 9 patients without intraventricular thrombi, none had systemic emboli.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006321:Heart / Q000033:anatomy & histology; D006333:Heart Failure / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size