Subendocardial ischemia without coronary artery disease: is elevated left ventricular end diastolic pressure the culprit?
BACKGROUND
The aim was to investigate the association between elevated left ventricular end diastolic pressure (LVEDP) and subendocardial ischemia.


METHODS
A retrospective chart review was performed of 1846 consecutive patients admitted between January and September 2002 who had chest pain, stress testing and coronary angiography.


RESULTS
1592 patients were excluded due to a positive coronary angiogram for coronary artery disease (CAD), 254 patients had an angiogram compatible with non-significant CAD and an ejection fraction > 45%; of whom 210 (82.7%) had a positive stress test (study group) and the others 44 (17.3%) had a negative stress test (control group). The mean LVEDP value for the study group (11.8 +/- 6.1 mmHg) was significantly higher than the mean LVEDP value for the control group (7.8 +/- 4.6 mmHg) (p < 0.001). In addition, there were more people with abnormal LVEDP (>or= 12 mmHg) in the study group (n = 103, 49.05%) compared with the control group (n = 10, 22.73%) (p < 0.001). Furthermore, the results of logistic regression revealed that patients with abnormal LVEDP values were 11 times more likely to have had a positive stress test.


CONCLUSIONS
There appears to be a positive association between elevated LVEDP and subendocardial ischemia that manifests as a positive stress test in patients without evidence of significant CAD.
Elhabyan
Abdul-Karim
AK
CAMC Health Education and Research Institute, West Virginia University, Charleston Area Medical Center, Charleston, West Virginia 25304, USA.
Reyes
Bernardo J
BJ
Hallak
Omar
O
Broce
Mike
M
Rosencrance
James G
JG
Lucas
B Daniel
BD
Fazal
Hamid
H
D001794:Blood Pressure; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003971:Diastole; D005080:Exercise Test; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology*; D012189:Retrospective Studies