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Changes in left ventricular ejection fraction during transient myocardial ischaemia in patients with angina pectoris
J Bech1, F H Pedersen, B K Madsen
1Department of Medicine B, Rigshospitalet, Copenhagen.
Insights
Silent ischemia, like angina pectoris, causes a significant drop in left ventricular ejection fraction during exercise. This finding highlights the cardiac impact of silent ischemia, even without chest pain symptoms.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Exercise Physiology
Background:
- Ischemia, a condition of reduced blood flow to the heart muscle, can manifest with or without symptoms like chest pain (angina pectoris).
- Silent ischemia, where heart muscle dysfunction occurs without typical angina symptoms, poses a diagnostic challenge.
- Left ventricular ejection fraction (LVEF) is a key measure of the heart's pumping efficiency.
Purpose of the Study:
- To compare the changes in left ventricular ejection fraction (LVEF) between patients with angina pectoris and those with silent ischemia during rest and exercise.
- To investigate the physiological response of the left ventricle in symptomatic versus asymptomatic ischemic heart disease.
Main Methods:
- The study involved 28 patients, divided into two groups: 14 with angina pectoris and 14 with silent ischemia.
- All patients underwent exercise thallium myocardial scintigraphy to confirm ischemia.
- Left ventricular ejection fraction was measured at rest and during exercise in both groups.
Main Results:
- A statistically significant decrease in LVEF was observed during exercise in both the angina pectoris group (44.0% to 39.5%, p=0.044) and the silent ischemia group (43.5% to 39.8%, p=0.045).
- The magnitude of the LVEF fall during exercise was comparable between the two groups (p=0.77).
- Transient ischemia was sensitively detected, confirming its presence in all participants.
Conclusions:
- Silent ischemia is associated with a significant reduction in left ventricular ejection fraction during exercise, similar to that seen in patients with angina pectoris.
- These findings underscore that silent ischemia has a demonstrable impact on cardiac function.
- The study confirms that reduced ejection fraction during exercise is a feature of both symptomatic and asymptomatic myocardial ischemia.
Abstract:
We compared the change in left ventricular ejection fraction during rest and exercise in 14 patients with angina pectoris and 14 patients with silent ischaemia. All patients had ischaemia defined as reversible defects at an exercise thallium myocardial scintigraphy. In the patients with angina pectoris the ejection fraction decreased from 44.0% (+/- 1 SD 13.4) at rest to 39.5% (+/- 1 SD 11.2) during exercise (p = 0.044). In the patients with silent ischaemia the ejection fraction decreased from 43.5% (+/- 1 SD 14.0) to 39.8% (+/- 1 SD 13.9) (p = 0.045). The fall in left ventricular ejection fraction in the two groups was almost identical (p = 0.77). This study confirms with a sensitive detection of transient ischaemia that silent ischaemia is accompanied with a fall in ejection fraction during exercise.