Khalid Khizer, Padda Jaskamal, Ismail Dina, Abdullah Muhammad, Gupta Dhriti, Pradeep Roshini, Hameed Warda, Cooper Ayden Charlene, Jean-Charles Gutteridge
Internal Medicine, Jean-Charles (JC) Medical Center, Orlando, USA.
Internal Medicine, AdventHealth & Orlando Health Hospital, Orlando, USA.
Cureus. 2021 Aug 30;13(8):e17550. doi: 10.7759/cureus.17550. eCollection 2021 Aug.
Ischemic heart disease (IHD) is the leading cause of death worldwide, and it is defined as an imbalance between myocardial oxygen supply and demand. Coronary artery disease (CAD) and left ventricular hypertrophy (LVH) are two common causes of IHD that independently result in myocardial ischemia. CAD decreases myocardial blood and oxygen supply whereas LVH increases myocardial oxygen demand. The coexistence of both CAD and LVH results in a significant increase in oxygen demand while simultaneously lowering oxygen supply. Since hypertension is a shared predisposing condition for both CAD and LVH, the left ventricular (LV) mass on noninvasive echocardiography can reflect on the severity of coronary artery stenosis. In clinical practice, it can help physicians decide whether to perform invasive cardiac catheterization to visualize the extent of the coronary block. Although, both CAD and LVH are directly proportional to mortality risk, the addition of eccentric LVH can further increase morbidity and mortality due to myocardial infarction. Therefore, the latest management of both the acute and chronic phases of CAD places an increased emphasis on controlling the predisposing factors to prevent or reverse LVH. For example, angiotensin-converting enzyme inhibitors and diuretics reduce LV mass by lowering the cardiac preload and afterload. This article aims to investigate the deleterious effects of the collaboration between CAD and LVH, establish a causal relationship, and explore the new prevention and management strategies.
缺血性心脏病(IHD)是全球主要的死亡原因,其定义为心肌氧供需失衡。冠状动脉疾病(CAD)和左心室肥厚(LVH)是IHD的两个常见病因,它们各自独立导致心肌缺血。CAD减少心肌血液和氧气供应,而LVH增加心肌氧需求。CAD和LVH同时存在会导致氧需求显著增加,同时降低氧供应。由于高血压是CAD和LVH共同的易感因素,无创超声心动图测得的左心室(LV)质量可反映冠状动脉狭窄的严重程度。在临床实践中,它可帮助医生决定是否进行侵入性心导管检查以观察冠状动脉阻塞的程度。虽然CAD和LVH均与死亡风险成正比,但偏心性LVH的存在会进一步增加心肌梗死导致的发病率和死亡率。因此,CAD急性和慢性阶段的最新管理更加注重控制易感因素以预防或逆转LVH。例如,血管紧张素转换酶抑制剂和利尿剂通过降低心脏前负荷和后负荷来减轻LV质量。本文旨在研究CAD与LVH协同作用的有害影响,建立因果关系,并探索新的预防和管理策略。