Background :
@EN Angina with normal coronary angiogram has been called syndrome X or microvascular angina, but pathophysiologic mechanisms for chest pain in this group of patients are not known exactly. To observe the changes of left ventricular function in
patients
with angina and normal coronary angiogram. The authors analyzed the left ventricular systolic and diastolic function with echocardiogram and cardiac catheterization
@ES Methods :
@EN The authors performed resting and treadmill exercise electrocardiogram, 201Tl dipyridamole scan, M-mode and Doppler echocardiogram, cardiac catheterization and coronary angiogram in patients with angina and normal coronary angiogram. The
systolic
and diastolic left ventricular function indices from M-mode and Doppler echocardiogram, left ventricular catheterization and coronary angiogram were analyzed in 12 patients excluding diabetes, hypertension, cardiomyopathy and esophageal motility
disorders among 1626 patients who underwent coronary angiogram between Jan. 1991 and Aug. 1992 in Chonnam University Hospital.
@ES Results :
@EN 1) Studied subjects were 12 patients, 5 male and 7 female, mean age was 51±9.4 year-old. Resting electrocardiograms were normal in 8 cases and ST-T changes in 4 cases. Ischemic ST-T changes were observed in all cases during treadmill
exericise
test
and perfusion defects in 3 cases out of 8 cases during 201Tl dipyridamole scan.
2) On echocardiogram, ejection fraction(EF) was 68.9±4.5%), fractional shortening(FS) 37.4±4.4%, ratio of left atrial to aortic root dimension(LAD/AOD) 1.2±0.1, OR slope 3.8±0.8cm/sec, mitral valve Doppler E/A velocity ratio[E/A(V)]
0.9±0.2,
mitral valve Doppler E/A area ratio[E/A(a)] 1.3±0.3, early diastolic deceleration rate(EDDR) 4.3±1.3m/sec2, isovolumic relaxation time (IVRT) 96.2±15.7msec, isovolumic contraction time (IVCT) 38.1±9.1 msec and aorti valve Doppler peak flow
velocity[Ao(V)] 0.8±0.2m/sec. EF, FS, IVCT and A(V) were normal, LAD/AOD and IVRT were increased, but E/A(V), E/A(a), OR slope and EDDR were decreased compared to normal subjects.
3) On cardiac catheterization and angiogram, mean left ventricular end-diastolic pressure was 15.3±5.1mmHg and ejection fraction by left ventriculogram 78.2±7.4%. There was no regional wall motion abnormality.
@ES Conclusion :
@EN Above results suggest that angina with normal coronary angiogram may be associated with impaired left ventricular diastolic function.
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