Reuben Ilia

Coronary collaterals in patients with normal and impaired left ventricular systolic function

One hundred and twenty consecutive patients with significant coronary artery disease, normal left ventricular systolic function and coronary collaterals (group A) were compared to 120 patients with the same characteristics but with left ventricular systolic dysfunction (group B). No significant differences were found between the two groups on age, hypertension, diabetes mellitus and smoking. The left ventricular end diastolic pressure was 16+/-7 in group A, and 24+/-9 in group B (P<0.01). The number of diseased vessels was similar in both groups. More completely occluded vessels were found in group B (155 vs. 101 in group A). No significant difference was detected between the two groups in the distribution of the diseased vessels. In both groups, the richest collateral supply was to the right coronary artery, followed by collaterals to the left anterior descending. The poorest supply was to the left circumflex. In conclusion, patients with normal and abnormal left ventricular systolic function have similar coronary collateral characteristics.

Patients with coronary collaterals and normal left ventricular systolic function: clinical, hemodynamic, and angiographic characteristics.

One hundred and twenty consecutive patients with significant coronary artery disease, normal left ventricular systolic function, and coronary collaterals were compared with 111 patients with the same characteristics but with no collaterals. No significant differ ences were found between the two groups in hypertension, diabetes mellitus, and smoking. The left ventricular end diastolic pressure was 16.4 ± 7 in the study group and 16.9 ±6.9 in the controls (NS). Significantly more diseased vessels were observed in the study group than in the control group (2.1 ±0.6 versus 1.7 ±0.6, p = < 0.001 ) . One hundred and one totally occluded vessels were found in the study group but only two in the control group. The richest collateral supply was to the right coronary artery: 94 sources to 85 diseased vessels (111%) including 66 sources to 52 totally occluded arteries (127%); to the left anterior descending: 59 sources to 89 diseased vessels (66%) including 37 sources to 33 totally occluded arteries (112%). The poorest supply was to the left circumflex: 17 sources to 69 diseased vessels (25%), including nine sources to 16 totally occluded arteries (56%). No collaterals were observed in 14 totally occluded vessels in the study group and in two of the controls, while the systolic function at rest was still normal. It is suggested that coronary collaterals are important in preserving left ventricular systolic and diastolic performance at least at rest. Not readily visible collaterals may also prevent systolic dysfunction.

Self-Terminating Ventricular Fibrillation During Variant Angina: A Case Report

The authors present a case report of self-terminating ventricular fibrillation during an episode of variant angina. The causes of ventricular fibrillation in this disorder and the possible mechanisms for its rare spontaneous interruption are discussed.

Left ventricular performance in patients with normal coronary arteries: hemodynamic characteristics and clinical follow-up

Of 111 patients with normal coronary angiograms, 68 patients had elevated left-ventricular end diastolic pressure and low-normal ejection fraction (Group I) while the other 43 patients had normal left ventricular end diastolic pressure and high normal ejection fractions (Group II). Although the number of patients was too small for meaningful statistical analysis, systematically a higher percentage of patients with diabetes mellitus, hypertension, hypercholesterolemia and smoking history was found in Group I. In contrast to the patients in Group II, patients in Group I tended to have more angina and ischemic events.