The influence of anatomic evolution of coronary artery disease on left ventricular contraction: An angiographic follow-up study of 300 nonoperated patients

Abstract

The impact of the evolution of obstructive coronary artery disease (CAD) on left ventricular (LV) function was studied in 300 nonoperated patients who had had two angiographic studies. The interval between studies ranged from 6 months to 10 years (mean 29.6 months). Quantitative analysis of LV contractions in right anterior oblique projections was performed with the use of a computer program for calculation of ejection traction (EF) and regional wall motion (RWM) according to the method of Leighton. No progression of CAD was found in 131 patients. Progression of CAD was found in 169 patients. In the patients without progression and in 75 patients who had progression to less than total obstruction, no changes in EF and RWM were found. In the 67 patients in whom progression from less than 90% narrowing to occlusion had occurred a significant decrease in EF and RWM was found. In the 27 patients with progression from subtotal narrowing to occlusion, however, no change in LV function was found. A myocardial protective value of angiographically visible preexistent collaterals could not be demonstrated. We conclude that absence of progression of CAD implies that LV function does not deteriorate and that slow progression to occlusion, via a stage of subtotal narrowing, generally does not influence LV function.