Discrete versus diffuse coronary artery stenoses clinical angiographic and echo-doppler studies

ABSTRACT

Forty subjects were admitted to catheterization laboratory at Ain Shams University Hospital with typical and atypical chest pain. According to the coronary angiogram, 30 patients had coronary artery disease [CAD]. These patients were further classified into discrete CAD [19 patients] and diffuse CAD [11 patients]. There was no statistically significant difference between the two groups with regard to age, sex, duration of the disease, symptoms or functional class. The diffuse CAD group had significantly higher prevalence of diabetes mellitus [p < 0.01] than the discrete CAD group. On the other hand, the discrete CAD group had a significant prevalence of anterior myocardial infarction [p < 0.05]. Coronary angiographic data revealed that in the discrete CAD group lesions tended to occur more frequently in the proximal segments whereas diffuse CAD had both proximal and distal segment involvement and a higher significance [p < 0.01] of mean coronary severity score. Echocardiographic and Doppler data revealed that diffuse CAD group had a significantly [P < 0.05] higher wall motion score [WMS] and non significant difference in ejection fraction [EF] than the discrete group. The diastolic function was impaired in the CAD patients. The diffuse CAD group had a highly significant increase in A wave and A/E ratio [p < 0.01] and a significant lower acceleration and deceleration than discrete CAD group. So, our results indicated that the diastolic dysfunction is inter-related to the severity and extent of CAD lesions. Therefore, the diagnosis of diffuse rather than discrete CAD which is an angiographic diagnosis, could not be predicted from the clinical data alone. Moreover, CAD patients were not prone to more adverse effects on the ventricular function [LV] apart from some impairment of left ventricular diastolic function as detected by pulsed wave Doppler ultrasound