Copyright © 1982 by the European Society of Cardiology.
© 1982 by The European Society of Cardiology
Ventricular arrhythmias in relation to coronary artery stenosis and left ventricular performance
Medical Department B, X-ray Department and Department of Clinical Physiology, Odense University Hospital Odense, Denmark
Received 27 January 1981; revised 11 May 1981; .
Abstract
The relationship between ischaemic heart disease and occurrence of ventricular arrhythmias has been studied in a prospective investigation of 41 patients with severe stable angina pectoris. The patients had a median age of 54 years (range 38–67). Following the therapeutic evaluation of the patients, they were subjected to exercise testing, 24 h ambulatory ECG monitoring, selective coronary arteriography, ventriculography and cardiac catheterization. Nineteen patients had been under treatment with a beta blocking agent, 16 with verapamil, three with both and three had not been receiving any anti-anginal treatment. The treatment was discontinued over a period of three days prior to coronary arteriography and haemodynamic measurements. A comparison of the patients under treatment with a beta blocking agent and those receiving verapamil demonstrated no difference in the non-invasive and invasive variables.
Ventricular arrhythmias were found in only one patient during exercise testing. The occurrence of ST segment deviation during exercise was not correlated with the number of stenotic coronary vessels due to low maximum heart rate and treatment. A heart rate during maximum exercise of < 120/min was observed significantly more frequently in patients with multivessel disease.
The data of the 24 h Holter monitoring were analysed in order to evaluate whether the prevalence (percentage number of patients with ventricular ectopic beats) or the persistence (number of 6 h periods with ventricular ectopic beats) is the better indicator of myocardial function and coronary artery anatomy. The results demonstrated a significant correlation between a high persistence and elevated left ventricular enddiastolic presure, high dp/dt/max/P, reduced ejection fraction as well as the number of stenotic coronary arteries and hypokinetic segments in the left ventricular wall. The latter correlation especially applies when the hypokinesia is localized to the anterior wall of the left ventricle.
It is concluded from this investigation that a high persistence of ventricular arrhythmias during 24 h of ECG monitoring reflects multivessel disease and poor left ventricular function. The combination of a high persistence of complicated ventricular arrhythmias and only a slight rise in heart rate during maximum exercise can possibly identify a group with an especially high risk of sudden cardiac death.
Key Words: 24 h Holter monitoring • coronary artery stenosis • exercise testing • left ventricular performance