Subendocardial ischemia without coronary artery disease: is elevated left ventricular end diastolic pressure the culprit?

Abstract

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 ± 4.6mmHg) (p < 0.001). In addition, there were more people with abnormal LVEDP (>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.