Severe atherosclerotic coronary artery disease, healed myocardial infarction and chronic congestive heart failure: analysis of 81 patients studied at necropsy.
Observations are described in 81 necropsy patients (aged 29 to 91 years [mean 62]; 77 [95%] men) with severe congestive heart failure (CHF) more than 3 months in duration, left ventricular (LV) transmural scar and greater than 75% cross-sectional area narrowing by atherosclerotic plaque of 1 or more of the 4 major epicardial coronary arteries. The duration of symptoms from initial onset of acute myocardial infarction (59 patients) or CHF (18 patients) or angina pectoris (2 patients) to death ranged from 0.5 to 18 years (mean 7.1) (2 unknown). Angina pectoris occurred at some time, however, in 31 patients (38%). Cause of death was CHF in 48 patients (59%), sudden (arrhythmia) in 16 (20%), acute myocardial infarction in 11 (14%), and emboli in 6 (7%). The heart weight ranged from 410 to 800 g (mean 585). Left or right ventricular thrombi or both occurred in 37 patients (46%), only 4 (10%) of whom had systemic emboli; of the 44 patients without intracardiac thrombi, none had any form of emboli. The severity of coronary narrowing was variable. In 24 patients (30%) only 1 artery was narrowed greater than 75% in cross-sectional area; in 22 patients (27%), 2 arteries were so narrowed; in 32 patients (39%), 3 arteries; and in 3 patients (4%), 4 arteries. The size of the LV scar also varied. Of the 81 patients, 58 (72%) had large scars (involving greater than 40% of the LV wall); 10 (12%) had moderate-sized scars (6 to 40% of the LV wall); and 13 (16%) had small scars (less than or equal to 5% of the LV wall).(ABSTRACT TRUNCATED AT 250 WORDS)
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D000787:Angina Pectoris / Q000473:pathology; D002921:Cicatrix / Q000473:pathology; D003327:Coronary Disease / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006333:Heart Failure / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D013997:Time Factors