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[Function of the left ventricle under dynamic load in patients with coronary heart disease with and without angina
Insights
Angina pectoris is not always necessary to indicate heart problems during exercise. Objective signs of ischemia, like reduced ejection fraction, can occur even without chest pain in coronary heart disease patients.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Coronary heart disease (CHD) affects left ventricular function.
- Assessing cardiac response to stress is crucial for patient management.
Purpose of the Study:
- To investigate objective signs of myocardial ischemia during exercise in patients with CHD.
- To determine if angina pectoris is a necessary indicator of exercise-induced ischemia.
Main Methods:
- Biplane cineangiocardiography was used to assess left ventricular function in 136 CHD patients during supine bicycle ergometry.
- Patients were categorized based on symptom limitation (angina vs. no angina) and history of myocardial infarction.
- Regional wall motion abnormalities and overall ventricular function were analyzed.
Main Results:
- A significant percentage of patients, both with and without angina, exhibited de novo asynergy during exercise.
- Left ventricular ejection fraction decreased and end-diastolic pressure increased significantly in all patient subgroups during exercise.
- These objective signs of ischemia occurred irrespective of the presence or absence of angina pectoris.
Conclusions:
- Objective indicators of hemodynamically relevant myocardial ischemia during dynamic exercise in CHD patients are not dependent on the occurrence of angina pectoris.
- Angina is not an indispensable symptom for identifying exercise-induced ischemia in coronary heart disease.
Abstract:
Overall left ventricular function and regional wall motion abnormalities visualized by biplane cineangiocardiography were examined in 136 patients with significant coronary heart disease during supine bicycle ergometry. The stress test was tolerated without symptoms in 57 patients (42%) (26 without previous myocardial infarction, 31 with infarction), whereas it was limited by angina pectoris in 79 (58%) (40 without previous infarction, 39 with infarction). A de novo asynergy during exercise was observed in a similar percentage in patients without angina (17/26 [65%] without infarction, 29/31 [94%] with infarction) than in those with angina (29/40 [73%] without infarction, 33/39 [85%] with infarction). During exercise, left ventricular ejection fraction decreased and enddiastolic pressure increased to the same extent in all four subgroups, all changes being highly significant. It is concluded that in patients with coronary heart disease objective signs of ischemia during exercise (de novo asynergy, fall in ejection fraction and rise in enddiastolic pressure) are observed independently of whether angina pectoris occurred or not. Thus, angina is not an indispensable symptom of the occurrence of hemodynamically relevant ischemia during dynamic exercise.