Elevated left ventricular filling pressure as a cause of angina in patients with normal coronary arteries

Bush, Charles A.; Fanning, William J.; Kolibash, Albert J.; Leier, Carl V.

doi:10.1016/0002-9149(82)92207-x

Cited by 11 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, there are no corresponding studies based on either catheterization or non invasive acquired data during isometric exer cise in syndrome X patients. Although not directly comparable, our data are in accor dance with the findings of Bush et al [8] who reported a significant increase in LVEDP in all patients who had chest pain during catheter ization, but in contrast to the data of Levy et al [39] who failed to show an increase in pulmo nary pressure during spontaneous episodes of transient ST segment depression.…”

Section: Ha T In Syndrome Xsupporting

confidence: 85%

“…It has been suggested that region al wall motion abnormalities during exercise or pacing are rather the result of demand isch emia [4,5,34,39]. Bush et al [8] found that 60% of syndrome X patients had an increased resting LVEDP, whereas all of them had a normal left ventricular ejection fraction. In this study, some of the patients who devel oped chest pain during cardiac catheteriza tion showed a dramatic rise in LVEDP (>24 mm Hg); and nitroglycerin produced re lief of the chest pain and a fall in end-diastolic pressure (<12mm Hg).…”

Section: Left Ventricular Dysfunction In Syndrome Xmentioning

confidence: 99%

“…Whereas many authors have demonstrated a left ven tricular systolic dysfunction using radionu clide angiography during exercise or pacing [4][5][6][7], there are only few reports on the occur rence of diastolic abnormalities in this clinical setting. Bush et al [8] and Schofield et al [9] found that some of the patients with angina and normal coronary angiograms as well as a normal left ventricular ejection fraction showed an increased resting left ventricular end-diastolic pressure (LVEDP). However, there are no studies showing the prevalence of exercise-induced diastolic function abnormal ities using either invasive or noninvasive techniques in patients with this clinical en tity.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Manolas¹

1993

Cardiology

View full text Add to dashboard Cite

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.

show abstract

Section: Ha T In Syndrome Xsupporting

confidence: 85%

Section: Left Ventricular Dysfunction In Syndrome Xmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Manolas¹

1993

Cardiology

View full text Add to dashboard Cite

show abstract

“…This does suggest that the small distal LAD artery in patients with chest pain, positive ETT and normal CAG might not just be a chance observation but there could exist a possible underlying association but we did not perform left ventricular end diastolic pressure in patients with normal CAG. Bush et al 15 noted in an earlier study that patient with elevated LVEDP may have anginal chest pain with angiographically normal coronary arteries. Myocardial infarction with 'normal' coronary arteries (MINCA) typically occurs in the under-50s 16,17,18 .…”

Section: Discussionmentioning

confidence: 98%

A Study of Patients With Normal Coronary Angiogram Over A Period of 14 Months in A Military Hospital

et al. 2013

View full text Add to dashboard Cite

Objectives: The objectives were to study the incidence of the normal coronary artery anatomy, to determine their clinical, electrocardiographic, stress testing, echocardiographic and angiographic characteristics. Methods: This is a retrospective study carried out in cardiac center, Combined Military Hospital, Dhaka, Bangladesh on patients seen during the period from November 2010 to Dec 2011. The coronary artery angiography data was collected by a check list and was revised by the authors. Results: Twelve hundred and two fifty patients who had coronary angiography which showed normal coronary artery or minor coronary artery disease were included in this study. 13% were females. The mean age of the patients was 45.6. 74% patients had one or more coronary risk factors and predominant risk factor was hypertension (31%). More than 50% patients had significant cardiac symptoms and about 40% study subjects were found to have prominent ECG changes which preclude noninvasive tests. Only 38% of study subjects underwent exercise ECG tests, among them 12% had positive ETT. Two hundred and forty nine patients (20%) had normal coronary artery anatomy. Right dominant circulation was found in 79% of the patients. Conclusions: The incidence of normal coronary artery anatomy is similar to those reported in other literatures. Although there are limitations of common noninvasive tests to exclude coronary artery disease, proper clinical evaluation and appropriate use of other noninvasive investigations will definitely reduce the burden of coronary angiogram in patients with angina or suspected ischemic heart disease. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16078 University Heart Journal Vol. 8, No. 2, July 2012

show abstract

Long‐term clinical course of patients with angina and angiographically normal coronary arteries

Voelker¹,

Euchner²,

Dittmann³

et al. 1991

Clinical Cardiology

View full text Add to dashboard Cite

Summary: In 88 of 103 consecutive patients with angina and normal coronary arteries, follow-up data could be achieved 6-1 I years (9.2 f 1.2 years) after diagnostic left heart catheterization. Three of these patients died during follow-up (two noncardiac deaths and one death with no identifiable etiology). One patient suffered a documented myocardial infarction. In 40 patients (47%) chest pain diminished, while symptoms were unchanged in 20 (24%) or even worse in 25 (29%). Resolution or persistence of chest pain could not be predicted either by the character of pain (typical vs. atypical), the presence of hypertension, a left bundle-branch block, a positive exercise electrocardiogram or pathological pulmonary artery pressures during exercise, documentation of myocardial bridges, local wall motion abnormalities, or a left ventricular enddiastolic pressure 2 13 mmHg. However, continuing chest pain was significantly more common in patients who revealed a 'slow-flow phenomenon' at initial coronary arteriogram.Thus, in patients with angina and normal coronary arteries the long-term course regarding frequency of morbid cardiac events is benign. However, more than half of the patients reported chest pain to be similar or even worse than at Catheterization. Most clinical and invasive results at initial evaluation had no predictive value for the persistence of symptoms. The impact of 'slow-flow' in cornnary arteriography, which was a phenomenon almost exAddre\\ f i x repnnts:

show abstract

Elevated left ventricular filling pressure as a cause of angina in patients with normal coronary arteries

Cited by 11 publications

References 0 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

A Study of Patients With Normal Coronary Angiogram Over A Period of 14 Months in A Military Hospital

Long‐term clinical course of patients with angina and angiographically normal coronary arteries

Contact Info

Product

Resources

About