Quantitative difference in "critical" stenosis between right and left coronary artery in man.

Abstract

Coronary artery stenoses that limit blood flow below demand are considered critical. In this comparative study we investigated whether the same degree of stenosis in either the proximal third of the right coronary artery (RCA) or the proximal third of the left anterior descending artery (LAD) causes critical flow reduction. Lesions were quantified from 35-mm cinefilms in multiple projections using a vernier caliper. These morphometric measurements were correlated with various manifestations of critical flow reduction, such as angina pectoris, development of collateral vessels and segmental wall motion abnormalities. In 13 patients with anginal pain and isolated RCA stenosis, the mean degree of obstruction was 63% area stenosis, which was significantly lower (p < 0.05) than that measured in 17 symptomatic patients who had isolated obstructions of the LAD (77% area stenosis). In patients with an identical degree of obstruction (78%) in either the LAD or RCA, collateral vessels were angiographically demonstrable in 53% of the RCA stenoses but in only 29% of the LAD stenoses. Furthermore, when the stenoses were less than 63% in the RCA and LAD, regional wall motion abnormalities were more frequently (p < 0.05) associated with RCA than with LAD stenoses. These observations indicate that a significantly smaller percent area of stenosis is critical in the RCA than in the LAD.

The effects of stenosis severity on the hemodynamic parameters—assessment of the correlation between stress phase angle and wall shear stress

“…3, as the stenosis severity increases, the difference between the time-averaged values over one cardiac cycle, the so called ''mean value'', of inlet and outlet pressure increases as well. Several experimental studies indicate that pressure gradients or changes in the blood flow can be detected when the cross-sectional luminal area is reduced by 80% (Rafflenbeul et al, 1980;Berguer et al, 1974;Mates et al, 1978;Feldman et al, 1978;May et al, 1963). But, in the actual circulation, studies have shown that resting flow is unaffected and remains constant until coronary lumen area is reduced by more than 96-99%.…”

Perfectionism Dimensions and Dependency in Relation to Personality Vulnerability and Psychosocial Adjustment in Patients with Coronary Artery Disease

“…The inclusion criteria for the study were age (18 years or older), ability to communicate in English or French, and ability to provide written informed consent. Clinically significant CAD was said to be present in any patient with 50% or greater narrowing of one or more of the major coronary arteries, since it has been shown that this leads to a significant reduction in flow (Rafflenbeul, Urthaler, Lichtlen, & James, 1980). Based on the results of the angiogram, sixty-four percent (n = 123) of the patients were classified with clinically significant CAD, 16% (n = 30) with nonsignificant CAD, and 21% (n = 40) with normal arterial functioning.…”

Oesophageal Function in Patients with Angina Pectoris: A Comparison of Patients with Normal Coronary Angiograms and Patients with Coronary Artery Disease

“…The control group comprised 21 patients with typ ical angina pectoris who were shown to have signifi cant coronary artery disease [15,16] (more than 50% reduction in intraluminal diameter of at least one major coronary artery), and who had undergone angi ography during the same period of time. Thirteen were female, 8 male, and they were aged 36-65 years (mean 50).…”