الفهرس 
Abstract.
Coronary Artery Disease and DiastolicOnly 14 pages are availabe for public view
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Abstract
ACS is a frequently encountered clinical entity that causes substantial morbidity and mortality (2). Diastolic dysfunction and CAD are interrelated. The complications of CAD, myocardial ischemia or infarction, are major causes of diastolic dysfunction (3). Two-dimensional echocardiography with Doppler is the best noninvasive tool to confirm the diagnosis of LVDD. Among other noninvasive tools, 12-leads ECG is a commonly used tool to assess LA enlargement, which is a marker of LVDD (17). The increase in LA dimensions because of rising intra-atrial pressure changes the geometry of atrial fibrils; this, in combination with non-homogenous fibrosis of the LA wall, interrupts the conduction of sinus impulses (16). P-max and Pwd are non-invasive markers showing the heterogeneous and unstable distribution of the impulses arising from the sinus node on a standard ECG. P-max is an indicator of the disrupted inter-atrial conduction, while Pwd shows the heteroge¬neous electrical conduction (18), (19). P-max and Pwd are used as non-invasive indicators in predic¬tion of the risk for AF in the patients with paroxysmal AF, mitral stenosis, aortic stenosis, dilated cardiomyopathy, acute MI, atherosclerotic heart disease and angina (20),(21),(22),(23),(24), (25). Pwd is a non-invasive marker for LVEDP and highly correlated to LAV. Pwd is another alternative for assessment of LVDD in CAD (17). Our results showed that the P-max, Pwd and corrected Pwd were significantly correlated with LAV, LAVI, and LV diastolic function grades among the studied ACS and CSA groups. The study also showed higher values in ACS group in comparison to CSA and control groups. In addition, the Pwd, P-max and corrected Pwd were significantly increased (P.value <0.01) toward higher grades of LVDD in the ACS and CSA groups. It can be said that the presence of LVDD is an important factor affecting P-max, Pwd and corrected Pwd with the highest values toward ACS groups. In our study, the LV systolic and diastolic dimensions and function were affected in ACS group compared to CSA and control groups. As well, LV systolic function showed a significant negative correlation toward higher values of Pwd, P-max corrected Pwd, LAV and LVDD grades. The LAV and LAVI values were significantly increased in ACS and CSA groups compared to control group. As well, the LAV and LAVI were significantly increased (P.value<0.01) toward higher LVDD grades in ACS and CSA groups. In addition, the LAV and LAVI had a significant positive correlation with P max, Pwd and corrected Pwd in ACS and CSA groups. The present study showed that LVDD echocardiographic parameters had a statistically significant statistical difference in patientspatient’s groups compared to control group, and they were almost identical in both ACS and CSA groups. In addition, the E/A ratio, septal E/e’ ratio and LV diastolic function grades had a significant positive correlation with P-max, Pwd and corrected Pwd. In our study, the septal E/e’ ratio, TDI septal e’, and E/A ratio had a significant positive correlation (P.value <0.01) to LAV, LAVI, and LV diastolic function. Moreover, the multiple regression analysis showed that the LAV and LAVI were the significant predictors of Pwd and P max. In our study, the multiple regression analysis showed that TDI septal e’ was the predictors of Pwd and corrected Pwd. In conclusion, the presence of a disturbance in intrar-atrial conduction and an inhomogeneous propagation of the sinus impulse in patients with ACS group and CSA group in comparedison to the control group are associated with an increased LAV and LAVI and associated with deleterious systolic and diastolic dysfunction. LVDD grades were associated with increased Pwd, P-max and corrected Pwd in patients with ACS group and CSA group in compared ison to control group. There werewas a positive correlation between Pwd, P-max and corrected Pwd and LAV, LAVI and LVDD grades.