Key result
Abnormal left ventricular end diastolic pressure (≥12 mmHg) was associated with an 11-fold higher likelihood of a positive stress test in patients without significant coronary artery disease.
Why the study?
Is elevated left ventricular end diastolic pressure associated with subendocardial ischemia in patients without significant coronary artery disease?
Case-Control (n=254)
Is elevated left ventricular end diastolic pressure associated with subendocardial ischemia in patients without significant coronary artery disease?
Elevated left ventricular end diastolic pressure is strongly associated with positive stress testing in patients with chest pain but no significant CAD, suggesting a mechanism for subendocardial ischemia in this population.
Answers are grounded in this paper and cite their sources.
Elevated LVEDP may signal subendocardial ischemia in nonobstructive CAD; leaves open prospective validation before practice change.
BACKGROUND: The aim was to investigate the association between elevated left ventricular end diastolic pressure (LVEDP) and subendocardial ischemia. METHODS: A retrospective chart review was performed of 1846 consecutive patients admitted between January and September 2002 who had chest pain, stress testing and coronary angiography. RESULTS: 1592 patients were excluded due to a positive coronary angiogram for coronary artery disease (CAD), 254 patients had an angiogram compatible with non-significant CAD and an ejection fraction > 45%; of whom 210 (82.7%) had a positive stress test (study group) and the others 44 (17.3%) had a negative stress test (control group). The mean LVEDP value for the study group (11.8 +/- 6.1 mmHg) was significantly higher than the mean LVEDP value for the control group (7.8 +/- 4.6 mmHg) (p < 0.001). In addition, there were more people with abnormal LVEDP (>or= 12 mmHg) in the study group (n = 103, 49.05%) compared with the control group (n = 10, 22.73%) (p < 0.001). Furthermore, the results of logistic regression revealed that patients with abnormal LVEDP values were 11 times more likely to have had a positive stress test. CONCLUSIONS: There appears to be a positive association between elevated LVEDP and subendocardial ischemia that manifests as a positive stress test in patients without evidence of significant CAD.
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Elhabyan et al. (2004) conducted a case-control in Chest pain without significant coronary artery disease (n=254). Abnormal left ventricular end diastolic pressure (≥ 12 mmHg) vs. Normal left ventricular end diastolic pressure was evaluated on Positive stress test (OR 11, p=< 0.001). Abnormal left ventricular end diastolic pressure (≥12 mmHg) was associated with an 11-fold higher likelihood of a positive stress test in patients without significant coronary artery disease.
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