Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve.
Key result
Patients with chest pain and abnormal vasodilator reserve had significantly reduced left ventricular ejection fraction during exercise compared to healthy controls (58% vs 66%, p<0.001).
Why the study?
Do patients with angina, normal epicardial coronary arteries, and abnormal vasodilator reserve demonstrate left ventricular dysfunction?
Population
33 patients with chest pain despite angiographically normal coronary arteries, and 52 control patients of…
Comparison
Coronary flow studies during atrial pacing after… vs Patients without pain during pacing, patients…
Design
Cross-sectional
Authors
Discussion
Loading...
Member takes
Implication
May indicate microvascular dysfunction in angina with normal arteries; leaves open whether flow measures guide therapy.
Key Points
- This research examines the relationship between left ventricular dysfunction and vasodilator reserve in patients with chest pain but normal coronary arteries.
- 33 patients with chest pain underwent coronary flow studies and gated blood pool scintigraphy
- Evaluated great cardiac vein flow, coronary resistance, and lactate consumption during atrial pacing
- Compared left ventricular ejection fraction and diastolic filling between patients with normal and abnormal vasodilator reserve
- Patients with chest pain and abnormal vasodilator reserve had significantly lower great cardiac vein flow (97 vs 150 ml/min, p<0.001)
- Ejection fraction during exercise was lower in patients with abnormal reserve (58% vs 66%, p<0.05)
- Impaired diastolic filling rate was noted in patients compared to controls (2.6 vs 3.2 end-diastolic volume/sec, p<0.005)
Study Design
Type
Observational (n=85)
Structured PICO
Do patients with angina, normal epicardial coronary arteries, and abnormal vasodilator reserve demonstrate left ventricular dysfunction?
P
Population
85 participants, comprising 33 patients with chest pain and normal coronary arteries and 52 healthy controls, evaluated for left ventricular function and coronary flow.
E
Exposure
Coronary flow studies during atrial pacing after administration of ergonovine, and resting and exercise gated blood pool scintigraphy.
C
Comparator
Patients without pain during pacing, patients with appropriate vasodilator reserve (n=7), and healthy controls (n=52).
O
Outcome
Left ventricular ejection fraction during exercise, coronary hemodynamics (great cardiac vein flow, coronary resistance, lactate consumption), and left ventricular diastolic filling.surrogate
Main Result
Absolute Event Rate: 58% vs 66%
p-value: p=<0.001
Patients with chest pain and normal coronary arteries but abnormal vasodilator reserve exhibit left ventricular systolic and diastolic dysfunction suggestive of myocardial ischemia.
Cite This Study
Cannon et al. (1985) conducted an observational in Angina pectoris with normal epicardial coronary arteries (n=85). Abnormal vasodilator reserve vs. Appropriate vasodilator reserve or healthy controls was evaluated on Left ventricular ejection fraction during exercise (p=<0.001). Patients with chest pain and abnormal vasodilator reserve had significantly reduced left ventricular ejection fraction during exercise compared to healthy controls (58% vs 66%, p<0.001).