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Left ventricular dysfunction secondary to ischemia in women with angina and normal coronary angiograms

Amalia Peix1, Aníbal González, Ernesto J García

  • 1Institute of Cardiology, La Habana, Cuba. peix@infomed.sld.cu

Journal of Women'S Health (2002)
|February 3, 2009
PubMed

Insights

This study shows that myocardial ischemia in women with cardiac syndrome X can cause reduced left ventricular ejection fraction (LVEF) after stress, similar to epicardial coronary lesions. This suggests myocardial stunning as a cause of angina in these patients.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Vascular Medicine

Background:

  • Cardiac syndrome X is often linked to microvascular disease, causing abnormal myocardial blood flow and perfusion.
  • Understanding the mechanisms behind syndrome X is crucial for effective patient management.

Purpose of the Study:

  • To determine if gated single photon emission tomography (SPECT) myocardial scintigraphy can detect myocardial ischemia through perfusion defects and reduced left ventricular ejection fraction (LVEF) in women with syndrome X.
  • To compare these findings with those in women with epicardial coronary lesions.

Main Methods:

  • The study involved three groups of postmenopausal women: syndrome X (Group I), epicardial coronary lesions (Group II), and controls (Group III).
  • Technetium-99m gated SPECT myocardial scintigraphy, brachial artery endothelial function assessment, and lipid profiles were performed on all participants.
  • Exercise-stress-rest protocol was used for SPECT imaging.

Main Results:

  • Group I and II showed reduced brachial artery vasodilator responsiveness compared to controls, indicating endothelial dysfunction.
  • There was no significant difference in the mean change in LVEF (DeltaLVEF) between Group I and Group II, but both were significantly lower than Group III.
  • A post-stress LVEF reduction greater than 5% was observed in 43% of Group I patients.

Conclusions:

  • Stress-induced ischemia is linked to post-stress LVEF reduction in postmenopausal women with typical angina and normal coronary angiography.
  • This reduction in LVEF may represent myocardial stunning, a consequence of microvascular dysfunction in cardiac syndrome X.
Abstract

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