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Clinical characteristics and follow-up in patients with microvascular angina
Hiroshi Suzuki1, Hitoshi Matsubara, Shinji Koba
1Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan. hrsuzuki@med.showa-u.ac.jp
Insights
Microvascular angina, characterized by small artery sclerosis, showed a favorable prognosis in a Japanese study. Most patients survived and experienced reduced or unchanged chest pain over 7 years.
Area of Science:
- Cardiology
- Vascular Medicine
- Internal Medicine
Background:
- Arteriosclerosis of small arteries is a primary cause of microvascular angina.
- While some studies suggest a favorable prognosis, progressive left ventricular dysfunction is a concern.
Purpose of the Study:
- To evaluate the long-term prognosis of microvascular angina in Japanese patients.
- To assess symptom persistence, cardiac events, and medication use after diagnosis.
Main Methods:
- Study included 86 Japanese patients with ischemic ST depression, normal coronary angiograms, and biopsy-confirmed small artery sclerosis.
- A 7.2-year follow-up involved questionnaires on symptoms, medication, and cardiac events.
- Survival rates and symptom changes were analyzed.
Main Results:
- 98.9% of patients survived the follow-up period.
- 35.3% reported persistent chest pain, with 18.8% unchanged and 11.8% lessened.
- No cardiac deaths or myocardial infarctions occurred; 63.5% used calcium antagonists, and 20.0% were off antianginal medication.
Conclusions:
- Microvascular angina, when diagnosed using strict criteria, demonstrates a favorable long-term prognosis.
- Effective management with medications like calcium antagonists contributes to positive outcomes.
- Further research into left ventricular function in these patients is warranted.
Abstract:
Arteriosclerosis of the small arteries is one of the main causes of microvascular angina, and although some reports have shown favorable prognoses, there is progressive reduction in left ventricular function. The present study evaluated the prognosis of microvascular angina in 86 Japanese patients (51 women, 35 men; average age, 59+/-9 years) who had ischemic ST segment depression, normal coronary angiograms and small artery sclerosis confirmed by endomyocardial biopsies. The mean follow-up period was 7.2+/-3.4 years. Questionnaires regarding their symptoms, cardiac medication, and new events were sent to all patients. Eighty-five patients (98.9%) were still alive at the end of the follow-up period. Chest pain remained in 35.3%; the degree of pain was unchanged in 18.8%, and had lessened in 11.8%. None of the patients died of cardiac events or suffered from a myocardial infarction. At the end of the follow-up period, calcium antagonist was used in 63.5% of patients. Seventeen patients (20.0%) were free of antianginal medication. The prognosis of microvascular angina diagnosed by strict criteria was favorable.