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Tests for ischaemia and left ventricular function in young patients with effort-induced chest pain
Insights
This study investigated angina pectoris in young adults, finding that even without coronary artery narrowing, abnormal lactate tests and elevated left ventricular stress suggest cardiac dysfunction. These findings highlight the importance of comprehensive cardiac assessment.
Area of Science:
- Cardiology
- Internal Medicine
- Physiology
Background:
- Angina pectoris diagnosis typically relies on coronary artery assessment.
- Younger patients with angina and normal coronary arteries present a diagnostic challenge.
- Left ventricular function and stress warrant investigation in these cases.
Purpose of the Study:
- To determine the type of angina pectoris in young adults (≤40 years).
- To evaluate left ventricular function and stress responses during atrial pacing.
- To correlate diagnostic findings with lactate concentrations.
Main Methods:
- Quantitative left cineventriculography and coronary arteriography were performed.
- Atrial pacing tests with lactate concentration measurements were conducted.
- Left ventricular function, mass index, and hoop stress were quantitatively assessed.
Main Results:
- Patients with atypical angina and normal coronaries (Group I) showed no pathological pacing but some abnormal lactate tests.
- Patients with typical angina and normal coronaries (Group II) had pathological pacing and lactate tests.
- Patients with significant coronary narrowing (Group III) all had pathological pacing tests.
- Elevated left ventricular mass index and hoop stress were observed in subgroups, suggesting disturbed left ventricular function.
Conclusions:
- Atypical and typical angina with normal coronary arteriography can be associated with abnormal lactate metabolism and increased left ventricular stress.
- Disturbed left ventricular function may contribute to angina symptoms even without significant coronary artery disease.
- Comprehensive cardiac evaluation, including functional and metabolic assessments, is crucial for diagnosing angina in young adults.
Abstract:
The type of angina pectoris was determined in 47 women and 27 men aged 40 or less who then underwent quantitative left cineventriculography, coronary arteriography and atrial pacing test with determination of lactate concentrations from arterial and coronary sinus blood samples. The 29/74 patients with atypical angina and no narrowings on coronary arteriography (Group I) gave no pathological atrial pacing tests but 9 had pathological lactate tests. Group II consisted of 27/74 patients with typical angina but normal coronary arteriography. In these the atrial pacing test was pathological in 20 and the lactate test in 11. Coronary narrowings of 50% or more were found in 18/74 patients (Group III), who all had pathological pacing tests but only 9 pathological lactate tests. No statistical differences could be elicited between diagnostic groups in the quantitative evaluation of left ventricular function and it could be regarded as normal in 42/74 patients. The left ventricular mass index exceeded the control level in 6 patients in Group I and in 10 patients in Group II who all had a net lactate production upon pacing. The end-diastolic volume index was above control level in 11 patients in Group II, in whom the ST depression in pacing test was the only finding indicating ischemia. The hoop stress values exceeded the control level in both of these subgroups. In Group III 7 patients had a high left ventricular mass index and 4 a billowing mitral leaflet. The changes observed suggest disturbed functioning of left ventricle.