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Elevated ejection fractions in patients with the anginal syndrome and normal coronary arteriograms
Insights
Patients with angina and normal coronary arteries may experience chest pain due to a hyperdynamic heart. This condition involves a small, overactive left ventricle, potentially linked to increased beta-sympathetic stimulation.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- The cause of chest pain in patients with anginal syndrome and normal coronary arteriograms remains unclear.
- Existing explanations do not account for observed electrocardiographic, hemodynamic, and myocardial metabolic abnormalities.
Purpose of the Study:
- To investigate potential causes of angina-like chest pain in patients with normal coronary arteries.
- To explore the role of left ventricular function in this patient group.
Main Methods:
- Review of historical, clinical, laboratory, and hemodynamic data from 45 patients.
- Analysis of left ventriculograms using single-plane cineangiography to measure left ventricular volume.
- Assessment of systolic ejection fractions and ventricular volumes (end-diastolic and end-systolic).
Main Results:
- Patients exhibited elevated ejection fractions (mean 0.80) and reduced ventricular volumes (mean EDV 83 ml, ESV 18 ml).
- Mean longitudinal and transverse segmental axis shortening during systole were 28.8% and 50.7%, respectively.
- Findings suggest a subset of patients have small hearts with hyperdynamic ventricular contraction.
Conclusions:
- Hyperdynamic ventricular contraction may cause transient, angina-like chest pain in patients with normal coronary arteriograms.
- The etiology of the hyperdynamic ventricle is unknown but may involve increased beta-sympathetic stimulation.
- This points to a novel mechanism for angina in patients without obstructive coronary artery disease.
Abstract:
The etiology of chest pain in patients with the anginal syndrome and normal coronary arteriograms has not been established. There has been no explanation for the association of electrocardiographic, hemodynamic, and myocardial metabolic abnormalities consistent with myocardial ischemia observed in some patients with this disorder. Historical, clinical, laboratory, and hemodynamic data of 45 patients (24 females, 21 males), mean age 47.5 years, with chest pain and normal coronary arteriograms are reviewed. Left ventriculograms were analyzed utilizing the single-plane cineangiographic measurement of left ventricular volume. Systolic ejection fractions for the 45 patients ranged from 0.66 to 0.91 (mean 0.80 +/- 0.01 SEM). Ventricular volumes determined angiographically revealed mean end-diastolic and end-systolic volumes of 83 +/- 5 ml and 18 +/- 2 ml, respectively. The mean changes in longitudinal and transverse segmental axis shortening that occurred during ventricular systole were 28.8% and 50.7%, respectively. These elevated values for ejection fraction, and reduced measurements of ventricular volumes, indicate that some patients with chest pain and normal coronary arteriograms may have small hearts with hyperdynamic ventricular contraction. These findings suggest that hyperdynamic ventricular contraction may play a causative role in the development of transient, angina-like chest pain in these patients. The etiology of the proposed hyperdynamic ventricle is unknown, but it may be attributable to increased beta-sympathetic stimulation of the myocardium.