Comorbid CAD and Ventricular Hypertrophy Compromise The Perfusion of Myocardial Tissue at Subcritical Stenosis of Epicardial Coronaries

TL;DR

This study uses a mathematical model to show that ventricular hypertrophy worsens myocardial perfusion at subcritical coronary stenosis, highlighting the need to consider both conditions in treatment planning.

Contribution

The paper introduces a mathematical model demonstrating how ventricular hypertrophy shifts perfusion sensitivity, revealing increased ischemic risk at less severe stenosis.

Findings

Patients with both CAD and hypertrophy are more sensitive to hemodynamic changes.

Myocardial hypoperfusion occurs at subcritical stenosis in comorbid patients.

Hypertrophy exacerbates perfusion compromise at lower stenosis levels.

Abstract

BACKGROUND: Most studies of CAD revascularization have been based on and reported according to angiographic criteria which don't consider the relation between the resulting effective flow distal to the stenosis and the demand of a hypertrophied myocardial tissue. MODEL: Mathematical model of the myocardial perfusion in comorbid CAD and ventricular hypertrophy using Poiseuille's law. The analysis yields that the curve, which represents the relation between the perfusion and the severity of CAD depending on angiographic and/or angiophysiologic criteria, is shifted to the right by the effect of myocardial tissue hypertrophy. The right shift of said curve, which is directly proportional to the degree of ventricular hypertrophy, indicates that the perfusion of the corresponding myocardial tissue is compromised at angiographically and/or angiophysiologically subsignificant stenosis of the supplying epicardial vessel. RESULTS: Patients with comorbid CAD and left ventricular hypertrophy are more sensitive to CAD-related hemodynamic changes. They are more prone to develop ischemic complications, than their peers with isolated CAD regarding the same degree of coronary stenosis. CONCLUSION: Patients with comorbid CAD and ventricular hypertrophy suffer from myocardial hypoperfusion at angiographically and/or angiophysiologically subcritical epicardial stenosis. Accordingly; the comorbidity of both diseases should be considered upon designing of the treatment regime.