Abstract 15881: Elevated Left Ventricular End Diastolic Pressure and Microvascular Coronary Dysfunction
Background: Elevated left ventricular end diastolic pressure (LVEDP) may be caused by multiple etiologies, including myocardial ischemia due to obstructive coronary artery disease. Microvascular coronary dysfunction (MCD) can also lead to ischemia. The relationship between MCD and elevated LVEDP has not been previously described.
Methods: We prospectively evaluated 63 women (age 54.2±10.9 yrs) with MCD, defined as persistent signs or symptoms of ischemia, evidence of ischemia on non-invasive testing, no obstructive CAD (luminal narrowing <50%) and abnormal coronary reactivity testing (CRT). All women had normal left ventricular ejection fraction and no valvular or pulmonary abnormalities. A pig tail catheter was used for LVEDP measurement. After LVEDP was obtained, we proceeded with CRT using a Doppler transducer-tipped guide wire (Volcano FloWire 300cm) in the mid LAD. Coronary flow reserve (CFR), change in coronary blood flow (CBF), change in epicardial coronary artery diameter were measured following intracoronary injections of 18mcg of adenosine, 10−4 acetylcholine (ACH) (18.2mcg/cc), and 200mcg of nitroglycerin (NTG), respectively. Two sample t-test, Fisher' exact test and Spearman correlation were used for analysis.
Results: Among 63 women sequentially tested, 50 (79%) had an elevated LVEDP > 12 mmHg, with a group mean of 15.2±4.3mmHg. Overall, LVEDP did not correlate with CRT variables: CFR r = 0.08 (p=0.509), CBF r = −0.13 (p=0.302), ACH r = −0.12 (p=0.334), NTG r = 0.04 (p=0.766). There were no differences between patients with normal vs. abnormal LVEDP (Table 1).
Conclusions: This is the first report demonstrating that LVEDP is frequently elevated in women with MCD. Elevated LVEDP does not appear to be related to CRT variables, suggesting that further investigation is needed.
- © 2010 by American Heart Association, Inc.