Alterations in left ventricular shape in patients with angina and single-vessel coronary disease.
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.
Fantini
F
F
Department of Internal Medicine, University of Florence, Italy.
Barletta
G
G
Di Donato
M
M
Toso
A
A
Baroni
M
M
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology*; D016022:Case-Control Studies; D003326:Coronary Circulation; D003327:Coronary Disease / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left