Angina Pectoris With Normal Coronary Arteries Transvenous Myocardial Biopsy in Diagnosis

Richardson, Peter J.; Livesley, Brian; Oram, Samuel; Olsen, E. G. J.; Armstrong, P.

doi:10.1016/s0140-6736(74)93260-7

Cited by 99 publications

(30 citation statements)

References 22 publications

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“…These diastolic func tion alterations are similar to those observed in coronary artery disease patients in only one third of patients, whereas in two thirds of them a 'nonischemic' or 'congestive' pattern of diastolic dysfunction was present. Thus, the presence of these handgrip-induced dia stolic abnormalities in patients with syn drome X support the pathophysiologic hy pothesis of the presence of cardiomyopathy based on characteristic histology findings [30] rather than that of myocardial ischemia due to abnormalities of coronary microcirculation [1,7].…”

Section: Discussionmentioning

confidence: 61%

Exercise-Induced Diastolic Abnormalities Assessed by Handgrip-Apexcardiographic Test in Syndrome X

Manolas¹

1993

Cardiology

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It has been shown recently that the handgrip-apexcardiographic test (HAT) represents a new mode of stress test, which shows a high sensitivity in identifying coronary patients by assessing exercise-induced ischemic left ventricular diastolic abnormalities. To assess the prevalence of left ventricular diastolic abnormalities and the usefulness of HAT as a diagnostic tool in patients with syndrome X (angina pectoris in the presence of normal coronary arteries), HAT was obtained in 275 clinically normal subjects and in 9 patients who presented with typical chest pain and who were subsequently found to have a positive treadmill ECG test and no coronary artery disease by angiography. As diastolic indices served: the relative A wave to total height (A/H) and to diastolic amplitude (A/D) of the apex tracing, the total apexcardiographic relaxation time (TART), TART corrected for the duration of diastole (TARTI) and the diastolic amplitude time index [DATI = TARTI/(A/D)]. Positivity of HAT was defined by the presence of at least one of the following recently introduced criteria: (1) A/H during or after handgrip > 21%, (2) TART during handgrip > TART at rest > 143 ms or/and TARTI during handgrip < 0.14 or (3) DATI during handgrip < 0.27. At rest, in 6/9 (67%) patients all variables were within normal limits, whereas in 3/9 (33%) patients an abnormal A/H or TARTI was observed. During and after handgrip, however, all patients showed abnormal changes in at least two diastolic variables, DATI and A/H being most frequently abnormal (67 and 56%, respectively). Further, using the above-mentioned positivity criteria, all patients had a positive HAT result. It can be concluded that according to our present findings an exercise-induced diastolic dysfunction is frequently present in syndrome X patients. Furthermore, using diastolic abnormalities as cutoff points and criteria of positivity, HAT shows a 100% sensitivity for detecting patients with this clinical setting.

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Section: Discussionmentioning

confidence: 61%

Exercise-Induced Diastolic Abnormalities Assessed by Handgrip-Apexcardiographic Test in Syndrome X

Manolas¹

1993

Cardiology

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“…These differences could not be explained by our having selected a particularly fit group of normal controls. Thus, analysis of the baseline exercise data in the 1832 group 2 subjects (figure (6) Normal thallium scans and EF increase during exercise by I % to 5% Normal findings (12) Normal thallium scans and EF increase in response to exercise by B 5%…”

Section: Resultsmentioning

confidence: 99%

False suspicion of coronary heart disease: a 7 year follow-up study of 36 apparently healthy middle-aged men.

Erikssen¹,

Dale²,

Rootwelt³

et al. 1983

Circulation

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Latent coronary heart disease was suspected in 115 of 2014 apparently healthy middleaged men after a baseline cardiovascular survey. One hundred five of these men underwent angiography and 36 were found to have normal coronary arteries (group 1). A 7 year follow-up survey revealed that: (1) three had died of sudden cardiac death, (2) four had received a diagnosis of cardiomyopathy, (3) one had developed aortic dilatation/aortic regurgitation since the baseline survey, (4) they all had a significantly more rapid decline in their physical performance and maximal heart rate levels from the time of the baseline survey to follow-up than did randomly selected normal controls (group 2), and (5) thallium study results were normal in both groups (27 and 26 patients), but technetium ventriculography revealed a subnormal increase in ejection fraction during exercise (< 5% units) in 14 of 27 group 1 subjects and in 4 of 26 group 2 subjects. Thus, incipient heart disease may be present in subjects in whom coronary angiographic examination has removed a previous suspicion of coronary heart disease.Circulation 68, No. 3, 490-497, 1983. EXERCISE ELECTROCARDIOGRAPHIC (ECG) testing is valuable in the evaluation of patients with chest pain and as a screening procedure in apparently healthy subjects. For the purpose of this study, performed 6 to 9 years after the one described above, the "angionegatives" were assigned to group I, and the men participating as control subjects (group 2) were selected as follows. Each time one of the men from group I was examined, the next man to be examined was designated a normal control subject, provided he belonged to the normal CIRCULATION

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“…Several mechanisms have been suggested to explain the pathogenesis of this syndrome: Pathological hemoglobin dissociation curve (Eliot and Bratt, I969), cardiomyopathic changes (Richardson et al, 1974), and a hypercontractile left ventricle (Mammohansingh and Parker, 1975), but in most patients none of these causes was found to be relevant (Selzer, 1977). Small vessel disease has been suggested but has not been found in the absence of a generalized vascular disorder.…”

Section: Discussionmentioning

confidence: 99%

Verapamil in effort‐induced angina pectoris in patients with normal coronary arteries

Hasin¹,

Rod²,

Lewis³

et al. 1982

Clinical Cardiology

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Summary: Two patients with classical effort‐induced angina pectoris associated with abnormal ST‐segment depression on graded exercise testing and normal coronary arteriograms are described. Both patients deteriorated during treatment with propranolol, and became asymptomatic during treatment with verapamil with normal graded exercise tests. Verapamil may thus improve an inadequate vasodilatatory response of the coronary vascular bed to effort.

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Angina Pectoris With Normal Coronary Arteries Transvenous Myocardial Biopsy in Diagnosis

Cited by 99 publications

References 22 publications

Exercise-Induced Diastolic Abnormalities Assessed by Handgrip-Apexcardiographic Test in Syndrome X

Exercise-Induced Diastolic Abnormalities Assessed by Handgrip-Apexcardiographic Test in Syndrome X

False suspicion of coronary heart disease: a 7 year follow-up study of 36 apparently healthy middle-aged men.

Verapamil in effort‐induced angina pectoris in patients with normal coronary arteries

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