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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a previous study performed in patients with effort angina pectoris, we showed that the dipyridamole-echocardiography test (DET) is feasible and useful for the detection of coronary artery disease. The positivity of the test (consisting of two-dimensional echocardiography [2 DE] combined with dipyridamole infusion [0.14 mg/kg/min for 4 minutes]) is linked to the appearance of regional asynergy. In the present study, DET and exercise stress test (EST) were performed in 62 patients with angina at rest in the active phase. The overall sensitivity of DET and EST for the detection of coronary artery disease was 62% and 83%, respectively (p less than 0.05); the specificity of DET and EST was 100% and 64%, respectively (p less than 0.05). In 10 DET-positive patients, a spontaneous attack was also monitored by 2DE; the myocardial wall involved by ischemia was invariably the same both in patients with spontaneous and in those with dipyridamole-induced ischemia. Thus, in our population of patients with angina at rest (in whom an important functional component is also likely to be present during exercise), DET was significantly less sensitive but significantly more specific than EST in detecting coronary artery disease.
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PMID:Dipyridamole-echocardiography test in angina at rest: noninvasive assessment of coronary stenosis underlying spasm. 395 91

In 35 subjects with typical or atypical angina and/or documented myocardial infarction (MI), body surface potential maps (BSPMs), ECG, VCG and rest Thallium-201 (T1-201) have been compared to left ventriculography (LVG). BSPMs were recorded with 26 ECGs, and BSPM abnormalities for MI cases were considered to be areas of normally positive potentials that have become negative. Subjects with MI were classified according to the segmental localization and degree of asynergy on LVG. Moderate anterolateral and apical asynergy were found to correlate with BSPM diagnosis of anterolateral MI and ischemia, severe anterolateral and apical asynergy with BSPM diagnosis of anterolateral MI and ischemia, and moderate diaphragmatic and/or posterobasal asynergy with BSPM diagnosis of posterior MI. Simultaneous anterior and posterior asynergy were found for BSPM diagnosis of anterior with posterior MI. Subjects with no LVG asynergy had normal BSPMs. BSPM diagnosis had the highest correlation coefficient with the LVG diagnosis (r = 0.88). ECG and VCG showed similar results with r = 0.65 and 0.71 respectively, while T1-201 had r = 0.55. The examination of our BSPMs, as well as the ECG, VCG and T1-201, did not permit to detect apical damage in presence of anterior MI, and posterobasal damage in the presence of inferoposterior MI. It is concluded that BSPMs are slightly superior to ECG and VCG for diagnosis of MI.
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PMID:Myocardial infarction diagnosis with body surface potential mapping, electrocardiography, vectorcardiography and thallium-201 scintigraphy: a correlative study with left ventriculography. 398 21

Left ventricular systolic and diastolic function were studied before and after surgical revascularization in a group of 24 patients with stable angina who all had an excellent clinical response to surgery. With use of micromanometer left ventricular pressure measurements and ventricular volumes, calculated from biplane cineangiograms, left ventricular function at rest and during exercise before and after surgery was compared. Before surgery all patients had exercise-induced ischemia with new asynergy, a fall in ejection fraction from 57% to 49% (p less than .001), and a rise in left ventricular end-diastolic pressure from 23 to 37 mm Hg (p less than .001). Postoperative exercise resulted in no new asynergy and ejection fraction rose from 59% to 61% (p less than .05). Left ventricular end-diastolic pressure still rose from 17 to 25 mm Hg (p less than .01). Left ventricular pressure decay during exercise was greatly improved after revascularization and allowed maintenance of reduced early diastolic pressures. The early diastolic pressure nadir before surgery rose from 9 to 21 mm Hg (p less than .001); the postoperative nadir was 5 mm Hg at rest and 6 mm Hg during exercise. All patients had an upward shift in the diastolic pressure-volume relationship during preoperative exercise. After revascularization there was no upward shift in some patients and a much smaller shift in others. The postoperative increase in left ventricular end-diastolic pressure was due to increased end-diastolic volume, not altered compliance. There was an increase in mean right atrial pressure during exercise either before (6 to 11 mm Hg) or after surgery (4 to 10 mm Hg). These increases were quite variable, suggesting no consistent role of pericardial restraint during exercise. Early diastolic peak filling rate during exercise was greater after surgery (1260 vs 950 ml/sec, p less than .001). In fact, during postoperative exercise early diastolic filling rates were greater than normal, reflecting the persistence of abnormally high atrial pressures for filling. As at preoperative study, late diastolic filling during exercise was restricted after revascularization when compared with that in a control group. Postoperatively patients undergoing bypass procedures with a good clinical result showed significantly improved left ventricular diastolic and systolic function. Persistent elevation of end-diastolic and atrial pressures and other abnormalities of diastolic function may reflect chronic structural changes and need to be taken into account when evaluating patients after bypass surgery.
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PMID:Left ventricular systolic and diastolic function in coronary artery disease: effects of revascularization on exercise-induced ischemia. 400 23

In order to verify the usefulness of long-term digitalis therapy during physical rehabilitation in patients with recent myocardial infarction (MI) and left ventricular disfunction during exercise, 24 consecutive pts with PAedP greater than or equal to 25 mmHg (Swan-Ganz cath.) at maximal work load were selected. Pts with angina, ST depression (greater than or equal to 2 mm), complex ventricular arrhythmias (Lown 4-5), symptoms of left ventricular failure were excluded. At random 12 pts were assigned to group A (digoxin therapy) and 12 to group B (no therapy). Serum digoxin level was on average 1.48 ng/ml (range 1-2.85 ng/ml). Both groups performed over 4 weeks the same controlled training program. Before and soon after the end of the training period all pts underwent to an exercise test, standard chest x-ray films, 24 hour ambulatory ECG and two-dimensional echocardiography. No complication was observed during exercise test and training period. Age, myocardial infarction location, cardiac volume and hemodynamic behaviour during the first exercise test were similar in both groups. After training, maximal work capacity was increased in group A by 14% and in group B by 16% without significant changes in PAedP and Cl; at the same work load PAedP was lower in group B (-12%, p less than .02) while LVSWI was increased in both groups (14% and 17% respectively, p less than .05). No significant changes in cardiac volume, left ventricular asynergy, EF, and ventricular premature beats were observed. QT interval at rest decreased significantly only in group A 408 +/- 31 msec vs 371 +/- 34 msec (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Recent myocardial infarction: role of digitalis therapy in patients with left ventricular dysfunction during exercise who participated in a short-term physical training program]. 400 49

The influence of severity of coronary artery disease (CAD) on the duration of corrected electrical systole (QTc) and the prognostic value to predict sudden death of this index were retrospectively evaluated in 123 non-consecutive patients with history of stable angina who underwent cardiac catheterization. Fifteen patients had no angiographic evidence of CAD (O-V group). The 108 patients with a greater than or equal to 70% luminal diameter narrowing of a major coronary artery were further subdivided: 23 patients had 1-vessel (1-V group), 40 patients had 2-vessel (2-V group) and 45 had 3-vessel (3-V group) coronary artery disease; 26 patients showed normal left ventricular (LV) wall motion (A group), 57 patients showed asynergic contraction of 1 or 2 LV areas (B group) and 25 patients showed 3 or more areas of asynergy and/or aneurysm. Sixty-one patients had a previous myocardial infarction (MI). QT interval, calculated in the lead where it was longer, on 12-lead resting electrocardiograms recorded at a paper speed of 25 mm/sec, was corrected by the formula: QTc = QT/square root R-R. The follow-up was performed by telephone. At the time of angiography there was no significant difference in QTc duration between the different groups according to the severity of CAD (O-V, 1-V, 2-V and 3-V groups). Patients showing three or more areas of abnormal segmental wall motion and/or aneurysm (C group) had a significantly longer QTc (p less than 0.05) than patients with normal LV wall motion (A group).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Influence of the angiocardiographic severity of ischemic heart disease on QTc duration]. 400 58

Studying the natural history of coronary artery disease could provide a frame of reference for prognosis and appraisal of treatment for patients having this disease. We studied a total of 465 consecutive patients with angiographically significant coronary artery disease, defined as greater than 50% stenosis in at least one principal artery, who were followed with medical treatment only from 1 to 7 years. Excluding patients with left main coronary disease, there were 73 deaths, of whom 63 were cardiac. The 5-year cumulative survival rates were 72% for the entire group, 87% for single vessel disease, 73% for double vessel disease and 51% for triple vessel disease. In single vessel disease, patients with left anterior descending artery involvement tended to have higher mortality. In double vessel disease, survival was worse with the combination of left anterior descending and right coronary artery involvements than the other 2 combinations. A history of myocardial infarction was not significantly different from angina in 5-year survival rate. Nevertheless, an abnormal Q-wave in ECG was associated with lower survival. History of hypertension and electrocardiographic left ventricular hypertrophy did not affect survival. While congestive heart failure, abnormal resting LVEDP and left ventricular asynergy were all associated with reduced survival. The left ventricular ejection fraction had highly prognostic value, only 42% of patients survived with ejection fraction less than 0.3 at the end of 5 years after angiography.
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PMID:Natural history of coronary artery disease in relation to angiographic, hemodynamic and clinical factors. 407 May 5

Fifty-five ischemic attacks at rest with ST segment elevation were recorded by two-dimensional echocardiography (2DE) in 20 patients with Prinzmetal angina. Eighteen ischemic attacks were recorded starting from intravenous injection of ergonovine maleate while 37 spontaneous ischemic attacks were recorded from onset of either anginal pain or ECG changes or from the basal state. In each ischemic attack at least one of the following transient alterations was observed by 2DE during ST elevation: (1) Regional hypokinesia, akinesia, or dyskinesia; (2) "step sign," that is, a sharp demarcation between an akinetic or dyskinetic area and an adjacent normal or hypercontracting region; and (3) geometric changes in left ventricular shape, that is, globular appearance in diastole and hourglass silhouette in systole. Regional myocardial asynergy was detected earlier than onset of pain (which was not present in 21 [38%] ischemic episodes) or ST segment elevation on ECG, as documented in 40 ischemic episodes (16 induced and 24 spontaneous) in which echocardiographic monitoring was performed from basal state and carried on up to the appearance of ischemia. All described mechanical changes were fully reversible after pain subsided and ST segment was back to isoelectric, either spontaneously or with nitrates; furthermore, a contractile "rebound phenomenon" of the previously ischemic wall was observed in some episodes. In conclusion, these results outline a role for 2DE in detecting cardiac mechanical impairment due to transient myocardial ischemia with ST segment elevation in humans.
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PMID:Transient changes in left ventricular mechanics during attacks of Prinzmetal angina: a two-dimensional echocardiographic study. 623 83

Left ventricular segments with reversible asynergy at rest demonstrate reversible myocardial perfusion defects on exercise thallium-201 scintigrams. To determine if improved perfusion eliminates asynergy at rest, 23 patients with angina (stable in 21, unstable in 2) were studied before and after coronary artery bypass surgery. All patients underwent exercise myocardial perfusion scintigraphy, contrast ventriculography and coronary arteriography before and after surgery. Selective graft angiography was performed during the postoperative catheterization to determine graft patency. Segmental ventricular function was quantitated by a regional fraction method. The scintigrams were divided into five regions and compared with the corresponding regions of the ventriculogram. Seventy-one of a possible 142 ventricular segments exhibited exercise-induced perfusion deficits. Preoperative regional ejection fraction was normal in 42 of these segments and abnormal in 29. Postoperatively, in 19 of the abnormal segments, function improved or normalized. All these segments had improved perfusion during exercise after surgery and were supplied by a patent bypass graft. Nine of the 10 segments in which abnormal wall motion persisted postoperatively continued to have exercise-induced perfusion deficits, and 9 of the 10 segments were supplied by an occluded or stenotic graft or one with poor run off. Of the 42 segments with normal wall motion preoperatively, 30 had improved perfusion after surgery and 35 maintained normal function. This study indicates that asynergy at rest is permanently reversed after coronary bypass surgery if improved myocardial perfusion can be documented. These findings are consistent with but do not prove the concept that reversible rest asynergy may reflect chronic ischemia or a prolonged effect from previous ischemic episodes.
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PMID:Improved regional ventricular function after successful surgical revascularization. 660 46

In view of the increased prevalence of so-called "ischemic cardiomyopathy" ( Burch ) in Japan, we attempted to clarify the clinical manifestations of this condition and to investigate the medical treatment in comparison with the surgical therapy. Eighteen patients (17 males and one female) were identified as having "ischemic cardiomyopathy" according to the following criteria: These include (i) an ejection fraction of 30% or less with asynergy on all segments of AHA classification, (ii) significant coronary stenosis (75% or more) of one or more major coronary branches, and (iii) no other coexisting lesion, such as primary valvular disease or congenital heart disease. In the history, distinct myocardial infarction or angina pectoris was observed in 10 cases (56%), and in the remaining eight cases (44%) only symptoms of cardiac failure was shown. On the ECG, all cases showed pathologic Q waves. Moreover, 10 cases (56%) of these had Q waves in five leads or more. Cardiomegaly on the chest X-ray film (CTR greater than or equal to 60%) was evident in 10 cases and that on echocardiogram ( LVDd greater than or equal to 60 mm) in 16 cases. Physical examinations demonstrated gallop sounds in 89% and a B-B' step formation on echocardiograms in 50%. The LVEDP was greater than 12 mmHg in 13 cases, and the systolic pressure of the pulmonary artery was higher than 35 mmHg in 13 cases. On the other hand, the reduced cardiac index (less than or equal to 2.21/min/M2) was observed in only one case. Selective CAG revealed multiple vessel disease in 78%. Ten of the 18 cases had mitral regurgitation demonstrated by left ventriculography.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical manifestations, therapeutic methods and prognosis of patients with ischemic cardiomyopathy]. 661 4

The purpose of this study was to examine the incidence and implications of false-negative exercise electrocardiographic results among 216 consecutive patients with angiographically documented coronary artery disease (50 percent diameter narrowing or greater of one or more vessels). Exercise electrocardiography gave negative (false-negative) results in 23 patients and positive (true-positive) results in 102 patients, and were nondiagnostic in the rest. Exercise thallium-201 imaging was performed in 88 patients. The extent of coronary artery disease was quantitated by a scoring system that takes into consideration the degree and site of narrowing in the major vessels and their branches. The exercise heart rate was higher in patients with false-negative than in patients with true-positive exercise electrocardiographic results (161 +/- 18 versus 133 +/- 24 beats per minute, mean +/- SD; p less than 0.0001). Q-wave infarction was present in two patients (9 percent) with false-negative and 20 patients (20 percent) with true-positive exercise electrocardiographic results (p = NS); left ventricular asynergy at rest was observed in 13 patients (57 percent) with false-negative and in 74 patients (74 percent) with true-positive results (p = NS). Patients with false-negative results had less extensive coronary disease than did patients with true-positive results (score 5.8 +/- 3.6 versus 9.2 +/- 5.0; p = 0.0025). Angina during exercise was less frequent in patients with false-negative results (p less than 0.01). Abnormal exercise thallium-201 images were seen in 15 of 20 patients (75 percent) with false-negative results and in 56 of 68 patients (82 percent) with true-positive results (p = NS). It is concluded that (1) false-negative exercise electrocardiographic results are infrequent (10 percent) among patients with coronary artery disease and are associated with less extensive coronary artery disease; (2) the frequency of Q-wave infarction and left ventricular asynergy is the same in patients with false-negative results as in patients with true-positive exercise electrocardiographic results; (3) exercise thallium images can identify 75 percent of patients with coronary disease and false-negative results of exercise electrocardiography.
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PMID:Implications of normal exercise electrocardiographic results in patients with angiographically documented coronary artery disease. Correlation with left ventricular function and myocardial perfusion. 661 30


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