Clinical and hemodynamic aspects of single vessel coronary artery disease

Abstract

Two-hundred consecutive patients with arteriosclerotic heart disease underwent complete clinical and hemodynamic evaluation. Fifty-two patients (26 per cent) had significant single vessel coronary artery disease and were compared to 148 patients with more extensive coronary artery disease and to a group of 14 normal patients. The single vessel disease group, when compared to the diffuse disease group, was characterized by a shorter duration of angina pectoris, lower frequency of a history of congestive heart failure or cardiomegaly, and a lower frequency of electrocardiographic (ECG) evidence of a transmural myocardial infarction. The combination of angina pectoris for three or more years with cardiomegaly was the only factor which completely separated the two coronary disease groups. Cardiomegaly, when present in single vessel involvement, was always due to left anterior descending (LAD) disease, together with an anterior infarction on ECG and left ventricular asynergy. The single vessel disease group included 32 patients with LAD disease, 17 with RCA, and 3 with circumflex artery involvement. Resting hemodynamics in these 52 patients (other than a higher left ventricular end-diastolic pressure and wall stress) were not significantly different from hemodynamics in a normal group. Patients with diffuse disease were characterized by many hemodynamic alterations and by left ventricular (LV) asynergy, when compared to the single vessel disease or normal groups. The diffuse disease group had a lower ejection fraction (EF) and an increased frequency of LV asynergy and coronary collateral circulation than did the LAD group. In the single vessel disease group LV asynergy did not correlate with the ECG. LV synergy, however, was not found in any patient in the LAD group with abnormal Q waves on ECG. The single vessel disease group included only five patients with increased end-diastolic volume (EDV) and all had LAD involvement, increased LV end-diastolic pressure, and decreased EF. The remaining 47 patients with normal LV-EDV revealed that the LAD group had abnormal pressure-volume relationships, indicating a decreased compliance of the left ventricle.