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Left ventricular dysfunction in patients with angina pectoris and normal coronary angiograms
Insights
In patients with angina and normal coronary angiograms, 25% showed left ventricular systolic dysfunction. Smoking may be linked to abnormal left ventricular wall motion in these individuals.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Angina pectoris often indicates coronary artery disease.
- However, some patients with angina have normal coronary angiograms, suggesting other underlying causes for their symptoms.
Purpose of the Study:
- To investigate left ventricular (LV) function in patients presenting with angina pectoris and normal coronary angiograms.
- To identify potential associations between LV dysfunction and clinical factors like smoking.
Main Methods:
- Left ventricular function was assessed using angiograms in 201 patients with angina and normal coronary arteries.
- Regional wall motion analysis was performed on 187 patients.
- Systolic and diastolic dysfunction were evaluated, along with left ventricular volumes, ejection fraction, and exercise capacity.
Main Results:
- Of the 187 analyzed, 66 patients exhibited hypokinetic segments, indicating regional wall motion abnormalities.
- Patients with hypokinesia had significantly higher end-systolic volume, lower ejection fraction, and reduced exercise capacity.
- Left ventricular diastolic dysfunction was present in 20% of patients, and 11% had both systolic and diastolic dysfunction.
- Smokers were significantly more prevalent in the group with hypokinetic segments.
Conclusions:
- A significant proportion of patients with angina and normal coronary angiograms exhibit left ventricular systolic and/or diastolic dysfunction.
- Smoking appears to be associated with left ventricular regional wall motion abnormalities in this patient cohort.
Abstract:
Left ventricular function was assessed in 201 patients who presented with angina pectoris and who were subsequently found to have completely normal coronary angiograms. Left ventricular angiograms from 187 patients were suitable for analysis of systolic regional wall motion; 121 were found to be normal and 66 had a total of 115 hypokinetic segments. Patients with hypokinesia had a significantly higher left ventricular end systolic volume and a significantly lower left ventricular ejection fraction and exercise capacity than those in whom regional wall motion was normal. Thirty one per cent of patients with normal wall motion and 30% of those with hypokinesia had a resting left ventricular end diastolic pressure greater than 15 mm Hg. There were significantly more smokers in the group with hypokinetic segments. Thus of patients with angina and normal coronary angiograms, 25% had evidence of left ventricular systolic dysfunction, 20% had evidence of diastolic dysfunction, and 11% had evidence of both systolic and diastolic dysfunction. The results suggest that smoking may be associated with left ventricular regional wall motion abnormalities.