Isolated stenosis of left anterior descending or right coronary artery: Relation between site of stenosis and ventricular dysfunction and therapeutic implications

Kumpuris, Andrew G.; Quiñones, Miguel Á.; Kanon, Donna; Miller, Richard R.

doi:10.1016/0002-9149(80)90599-8

Cited by 28 publications

(5 citation statements)

References 31 publications

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“…Moreover, the location of the lesion of the LAD in relation to the first septal perforator or the first diagonal branch did not predict the the degree of left ventricular function. Our results thus differ from those of Kumpuris et al who found a direct relation between the site of disease and the impairment of left ventricular function [14].…”

Section: Discussioncontrasting

confidence: 99%

Assessment of left ventricular function in patients with isolated severe disease of the left anterior descending artery: Clinical, electrocardiographic, hemodynamic, and angiographic correlations

Iskandrian

Weber

Mundth

et al. 1981

Cathet. Cardiovasc. Diagn.

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The purpose of this study was to define the spectrum of left ventriculographic (LV) abnormalities in 60 patients with isolated Greater Than or Equal To 90% diameter narrowing of the left anterior descending artery (LAD). The patients were divided into three groups: Group I (26 patients) had normal left ventricular (LV) function with ejection fraction (EF) of Greater Than 60% and no akinetic-dyskinetic segment representing abnormal contracting segments (ACS) of the left ventricular wall; Group II (15 patients) had mild to moderate LV dysfunction with EF of 40-60% and an akinetic-dyskinetic segment of Less Than 30% of the end diastolic perimeter (0-30%; mean, 11.6%) and Group III (19 patients) had severe LV dysfunction with EF Less Than 40%, or an akinetic-dyskinetic segment of Greater Than or Equal To 30% (30-81%; mean, 41.5%) or both. The data obtained from the history, physical examination, electrocardiogram (ECG), chest x-ray studies, hemodynamic studies, left ventriculography, and coronary arteriography were entered and filed on a memory disc in an IBM 370-168 computer. Analysis of the results showed: 1) more severe LV dysfunction is associated with increased incidence of large hearts, gallops, decreased cardiac output, and occlusion of the LAD. 2) ECG evidence of infarction is also associated with higher incidence of the abnormalities of the indices of LV dysfunction. 3) LAD occlusion (versus stenosis) has a higher incidence of severe LV dysfunction and prior infarction. 4) The site of LAD disease did not predict the extent of left ventricular dysfunction. 5) Collaterals did not protect against severe LV dysfunction.

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Section: Discussioncontrasting

confidence: 99%

Assessment of left ventricular function in patients with isolated severe disease of the left anterior descending artery: Clinical, electrocardiographic, hemodynamic, and angiographic correlations

Iskandrian

Weber

Mundth

et al. 1981

Cathet. Cardiovasc. Diagn.

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show abstract

“…This finding is consistent with reports cited above (Brooks et al, 1982;Califf et al, 1983; Gordon and Kerber, 1977;Johnson and Kayser, 1983;Kumpuris et al, 1980;Rahimtoola, 1984;Schuster et al, 1981;Taylor et al, 1980). A reason usually offered for this is the larger myocardial region at risk of ischemia from chronic ischemia or from a single occlusive event with the proximal lesion (Gordon and Kerber, 1977;Hutter, 1980;Kumpuris et al, 1980;Rahimtoola, 1984). This is consistent with the finding of a lower ejection fraction with proximal obstruction in our data (Table I) et al (1981), however, demonstrated that infarct size at postmortem examination was only slightly larger with proximal than with distal LAD disease.…”

Section: Discussionsupporting

confidence: 92%

“…Ejection fraction is lower and number of abnormally contracting segments is higher with the proximal lesion (Brooks et al, 1982;Taylor et al, 1980). Kumpuris et al (1980) documented abnormal systolic left ventricular function in the absence of prior infarction only in patients with proximal LAD lesion; in subjects with prior infarction, dysfunction was more severe with proximal than with distal LAD disease. In that study, the position of an isolated right coronary artery lesion was not determinative.…”

Section: Discussionmentioning

confidence: 95%

Natural history of left anterior descending coronary artery obstruction: Significance of location of stenoses in medically treated patients

Samaha

Connor

Tribble

et al. 1985

Clinical Cardiology

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Summary:We examined the prognostic significance of an obstmctive lesion in the proximal left anterior descending (LAD) coronary artery. Five-year or longer followup data were examined from 3 1 1 patients with > 70 % obstruction of the LAD treated without surgery. Mortality was compared in subsets with lesions proximal to and distal to the first septal perforating artery. Survival curves were worse in patients with proximal than with distal LAD disease (p <0.05); lesion location remained a significant determinant of survival when ejection fraction, age, and sex were controlled using a Cox regression model. However, when patient subsets were examined, survival with proximal LAD disease was worse than with distal obstruction only in the presence of an associated right coronary artery lesion and an ejection fraction of less than 40% (p

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“…'7 The best therapy for patients with one-vessel disease is still controversial. [18][19][20] Several studies suggest that the annual mortality rate of one-vessel disease treated medically is generally higher in patients with left anterior descending coronary artery disease than in patients with right coronary artery disease or left circumflex disease. Mortality rates undoubtedly depend on left ventricular function: The worse the function, the poorer the prognosis.…”

mentioning

confidence: 99%

Assessment of jeopardized myocardium in patients with one-vessel disease.

Iskandrian¹,

Lichtenberg²,

Segal³

et al. 1982

Circulation

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SUMMARY The size of the perfusion defect was assessed from a quantitative analysis of exercise thallium-201 images. Quantitative analysis was determined by measuring the area and the perimeter of the perfusion defect and expressing it as a percentage of the total left ventricular area or perimeter in three projections. Using this technique, we studied 50 patients with one-vessel disease of 50% or greater diameter narrowing. The planimetric and the perimetric methods correlated well (p < 0.001, r = 0.97). Of the 11 patients with less than 70% diameter narrowing, only one patient had abnormal exercise thallium-201 images. Of the remaining 39 patients with 70% or greater diameter narrowing, 35 circumflex disease. Mortality rates undoubtedly depend on left ventricular function: The worse the function, the poorer the prognosis. Therefore, the extent of jeopardized myocardium may have prognostic importance in patients with one-vessel disease; patients with more jeopardized myocardium may be at a higher risk of developing severe left ventricular dysfunction in the event of myocardium infarction. The purpose of this study was to assess the extent of jeopardized myocardium in patients with one-vessel disease by using quantitative analysis of exercise images, a simple technique that does not require computer manipulation, and to define the factors that affect the size of the defects in these patients. Materials and MethodsWe reviewed our records of exercise thallium-201 imaging and identified 50 patients with one-vessel disease who had undergone exercise perfusion imaging within 3 months of coronary angiography. There were 46 men and four women, ages 32-63 years (mean 52 years). Patients with associated cardiac diseases such as valvular heart disease or idiopathic hypertrophic subaortic stenosis and patients who had had previous bypass surgery were excluded.All patients were evaluated for symptoms of angina pectoris. No patient had unstable angina or historic or electrocardiographic evidence of myocardial infarction. Left-and right-heart catheterization, left ventriculography and coronary arteriography were per- formed with standard techniques. Each coronary vessel was visualized in multiple projections, including the sagittal oblique projection. Each patient had at least 50% diameter narrowing of one coronary artery. The lesion in the left anterior descending artery was classified as either proximal or distal to the first septal perforator and diagonal branches. In each patient with left circumflex artery disease, the lesion was before or involved the major posterolateral branch. In each patient with right coronary artery disease, the lesion was before the crux. The coronary circulation was rightdominant in patients with left circumflex or right coronary artery disease. The remaining vessels were either free of disease or had only slight luminal irregularities.Collaterals were considered present and significant if the collateral flow partially or completely opacified the diseased vessel beyond the site of occlusion or ...

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Isolated stenosis of left anterior descending or right coronary artery: Relation between site of stenosis and ventricular dysfunction and therapeutic implications

Cited by 28 publications

References 31 publications

Assessment of left ventricular function in patients with isolated severe disease of the left anterior descending artery: Clinical, electrocardiographic, hemodynamic, and angiographic correlations

Assessment of left ventricular function in patients with isolated severe disease of the left anterior descending artery: Clinical, electrocardiographic, hemodynamic, and angiographic correlations

Natural history of left anterior descending coronary artery obstruction: Significance of location of stenoses in medically treated patients

Assessment of jeopardized myocardium in patients with one-vessel disease.

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