Effects of the cold pressor test on the left ventricular function of patients with coronary artery disease

We used the cold pressor test as provocative of myocardial ischemia in 23 subjects evaluated for chest pain on effort. Seven of them (group N) had normal coronary arteries, and 16 (group CAD) had critical stenoses along the main branches of the left coronary artery. In both groups exposure to cold induced increase in arterial pressure and double product. Left ventricular end-diastolic pressure increased +60% from baseline (P less than 0.001). Angiocardiographic parameters, unchanged in group N, showed an impairment of left ventricular function in group CAD. End-diastolic volume increased +11% (P less than 0.01), ejection fraction decreased -8% (P less than 0.0025), with a significant reduction in segmental wall motion in the area of the diseased artery (P less than 0.001). The mean Vcf was slightly and not significantly reduced, while early-systolic and end-diastolic stress and the constant of stiffness consistently increased in both groups. The appearance or extension of ventricular wall contraction abnormalities in group CAD, in the absence of demonstrable coronary spasm and in the presence of a remarkable increase in left ventricular end-diastolic pressure and stress, was interpreted as due to ischemia secondary to increased extravascular resistances to coronary flow. The cold pressor test is proposed as a useful tool for the diagnosis and evaluation of patients with ischemic heart disease.

Left ventricular aneurysm. A radiographic method for quantitative angiocardiography with reconstruction of ventricular geometry

A method is presented for the measurement of ventricular aneurysms (An) by which the ventricle is considered to be composed of an ellipsoid or contracting portion and a hemispheroid or aneurysmal portion. Validation of the method with radio-opaque plastic models gave a difference between true and calculated volume measurements of not more than +/- 5%. In one hundred patients with aneurysms of different size and location the absolute volume of the aneurysm and its percentage of total left ventricular volume (V An %) were measured, and the statistical correlation with several hemodynamic and angiographic parameters was studied. Cardiac index (CI) and stroke volume (SV) appeared to decrease with increasing V An %, but with a correlation of no statistical significance. Left ventricular end-diastolic pressure (LVEDP) is raised with increasing V An %, but with a low statistical significance. Of angiographic parameters, end-diastolic volume (EDV) increased progressively and significantly with increasing V An %. This result is related to the extension of the noncontracting segment. Global ejection fraction (EF) decreased progressively with increasing enlargement of the aneurysm, in a statistically high correlation, and seemed to be the most sensitive index of total ventricular performance. Ejection fraction of the contractile portion (EFcp) was not related to V An % as involvement of large ventricular areas was consistent with preservation of contraction in unaffected regions. Evaluation of this parameter is suggested as a method of assessment for surgical treatment.

["Variant" angina: clinical, electrocardiographic and coronarographic aspects in 40 cases. Considerations for treatment (author's transl)]

Forty patients with chest pain and the electrocardiographic aspects of Prinzmetal's variant angina were studied by means of selective coronary arteriography. In 36 cases (90%) severe coronary lesions could be demonstrated: in 75% of the cases a critical obstruction involved a single major coronary trunk; only in 15% two or more vessels were affected. The vessel most frequently involved by critical obstruction was the left anterior descending (57%); in 5 cases (12.5%) a severe stenosis of the common left coronary trunk was present. In 8 cases critical stenosis were reduced by coronary dilators and were completely resolved in 2 cases. Peripheral lesions with multiple secondary branches involvement were present in none of the cases. A common finding was the absence of evident collateral anastomotic circulation. The comparison of the electrocardiographic manifestations of the anginal crisis and the angiographic findings showed a strict correlation between the area of subepicardial lesion and the major coronary vessel distributing to the corresponding myocardial region. Of the 40 patients, 17 were treated medically and 23 underwent a surgical aortocoronary bypass: the results (surgical mortality 22%; complete success 52%) are compared with those in the literature. Prognosis appears to be severe: coronary arteriography must be performed under criteria of urgency, and the possibilities of treatment must be considered on the basis of the angiographic findings.