February 1, 1985Circulation240 citationsOpen Access
View Full PaperLeft 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).
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
Patients with chest pain and normal coronary arteries but abnormal vasodilator reserve exhibit left ventricular systolic and diastolic dysfunction suggestive of myocardial ischemia.
Main Result
Absolute Event Rate: 58% vs 66%
p-value: p=<0.001
Abstract
Thirty-three patients with chest pain despite angiographically normal coronary arteries underwent both coronary flow studies during pacing and resting and exercise gated blood pool scintigraphy. During atrial pacing after administration of ergonovine, those patients developing their typical chest pain demonstrated significantly lower great cardiac vein flow (97 +/- 31 vs 150 +/- 33 ml/min, p less than .001), higher coronary resistance (1.27 +/- 0.43 vs 0.77 +/- 0.18 mm Hg/ml/min, p less than .005), and less lactate consumption (30.5 +/- 22.0 vs 69.7 +/- 41.1 mM . ml/min, p less than .005) and a higher left ventricular end-diastolic pressure after pacing (20 +/- 4 vs 12 +/- 1, p less than .001) compared with those without pain and in the absence of significant luminal narrowing of the epicardial coronary arteries. The 26 patients with abnormal vasodilator reserve demonstrated reduced left ventricular ejection fraction during exercise (58 +/- 8%) compared with the seven patients with appropriate vasodilator reserve (66 +/- 4%, p less than .05) and with a group of 52 control patients of similar age and sex distribution and free of known heart disease (66 +/- 10%, p less than .001). In addition, 12 of the 26 patients with abnormal vasodilator reserve demonstrated exercise-induced regional wall motion abnormalities. Many of these patients also manifested impaired left ventricular diastolic filling at rest compared with the control subjects (peak filling rate 2.6 +/- 0.7 vs 3.2 +/- 0.7 end-diastolic volume/sec, p less than .005). Thus, patients with chest pain resulting from abnormal vasodilator reserve demonstrate abnormalities of left ventricular systolic and diastolic function suggestive of myocardial ischemia.