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Unstable angina of crescendo pattern vs new onset: a clinical, coronary arteriographic and hemodynamic study
K M Hussain1, L Gould, T Bharathan
1Department of Medicine, New York Methodist Hospital, Brooklyn 11215, USA.
Insights
Crescendo angina patients exhibit more severe coronary artery disease and impaired left ventricular function compared to new-onset angina. This highlights distinct risk profiles and informs management strategies for unstable angina.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Unstable angina presents with varied clinical manifestations and risk levels.
- Understanding prognostic factors is crucial for effective management strategies.
Purpose of the Study:
- To investigate the prognostic significance of crescendo angina versus new-onset angina.
- To evaluate baseline characteristics, coronary lesions, and left ventricular function, including alterations during atrial pacing.
Main Methods:
- Digital subtraction ventriculography was used to assess coronary arteriographic anatomy and left ventricular function in 36 patients (18 crescendo, 18 new-onset angina).
- Measurements included left ventricular volumes and ejection fraction at rest and during atrial pacing.
Main Results:
- Triple-vessel disease was more prevalent in crescendo angina (56%) than new-onset angina (11%).
- Intracoronary thrombi were found in 33% of crescendo angina patients versus 4% of new-onset angina patients.
- Crescendo angina patients showed higher ventricular volumes and lower ejection fraction at rest, with a significant drop in ejection fraction during pacing.
Conclusions:
- Crescendo angina is associated with more complex coronary artery disease and poorer left ventricular function compared to new-onset angina.
- These findings underscore the need for tailored management strategies based on angina type and severity.
Abstract:
Unstable angina includes a variety of clinical presentations with a different level of risk for an unfavorable outcome. In this study the authors investigated the prognostic significance of crescendo angina and new-onset angina to discuss management strategies, paying attention to the relevance of baseline clinical characteristics, coronary artery lesions, and left ventricular function, as well as their alterations during atrial pacing. Accordingly coronary arteriographic anatomy and changes in left ventricular volumes and ejection fraction before and during atrial pacing were studied by means of digital subtraction ventriculography in 18 patients with crescendo angina and in 18 patients with new-onset angina. Triple-vessel disease was more frequently observed in crescendo angina (56%; P < 0.05) as compared with the patients with new-onset angina (11%). Complex coronary morphology was statistically more likely to be found in crescendo angina. The angiographic evidence of intracoronary thrombi was found in 33% (P < 0.05) patients with crescendo angina and in 4% patients with new-onset angina. Compared with the patients with new-onset angina, patients with crescendo angina had higher end-diastolic and end-systolic volumes and lower ejection fraction at rest. At peak pacing, ejection fraction was significantly (P < 0.05) lower in crescendo angina (0.48 +/- 0.06) than in new-onset angina (0.66 +/- 0.04). In crescendo angina, during pacing, the magnitude of velocity of circumferential fiber shortening was significantly decreased as compared with new-onset angina.(ABSTRACT TRUNCATED AT 250 WORDS)