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British Heart Journal logoLink to British Heart Journal
. 1986 Oct;56(4):327–333. doi: 10.1136/hrt.56.4.327

Left ventricular dysfunction in patients with angina pectoris and normal coronary angiograms.

P M Schofield, N H Brooks, D H Bennett
PMCID: PMC1236866  PMID: 3768211

Abstract

Left ventricular function was assessed in 201 patients who presented with angina pectoris and who were subsequently found to have completely normal coronary angiograms. Left ventricular angiograms from 187 patients were suitable for analysis of systolic regional wall motion; 121 were found to be normal and 66 had a total of 115 hypokinetic segments. Patients with hypokinesia had a significantly higher left ventricular end systolic volume and a significantly lower left ventricular ejection fraction and exercise capacity than those in whom regional wall motion was normal. Thirty one per cent of patients with normal wall motion and 30% of those with hypokinesia had a resting left ventricular end diastolic pressure greater than 15 mm Hg. There were significantly more smokers in the group with hypokinetic segments. Thus of patients with angina and normal coronary angiograms, 25% had evidence of left ventricular systolic dysfunction, 20% had evidence of diastolic dysfunction, and 11% had evidence of both systolic and diastolic dysfunction. The results suggest that smoking may be associated with left ventricular regional wall motion abnormalities.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arbogast R., Bourassa M. G. Myocardial function during atrial pacing in patients with angina pectoris and normal coronary arteriograms. Comparison with patients having significant coronary artery disease. Am J Cardiol. 1973 Sep 7;32(3):257–263. doi: 10.1016/s0002-9149(73)80130-4. [DOI] [PubMed] [Google Scholar]
  2. Bass C., Wade C., Hand D., Jackson G. Patients with angina with normal and near normal coronary arteries: clinical and psychosocial state 12 months after angiography. Br Med J (Clin Res Ed) 1983 Nov 19;287(6404):1505–1508. doi: 10.1136/bmj.287.6404.1505. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bemiller C. R., Pepine C. J., Rogers A. K. Long-term observations in patients with angina and normal coronary arteriograms. Circulation. 1973 Jan;47(1):36–43. doi: 10.1161/01.cir.47.1.36. [DOI] [PubMed] [Google Scholar]
  4. Benjamin S. B., Castell D. O. Chest pain of esophageal origin. Where are we, and where should we go? Arch Intern Med. 1983 Apr;143(4):772–776. [PubMed] [Google Scholar]
  5. Berger B. C., Abramowitz R., Park C. H., Desai A. G., Madsen M. T., Chung E. K., Brest A. N. Abnormal thallium-201 scans in patients with chest pain and angiographically normal coronary arteries. Am J Cardiol. 1983 Aug;52(3):365–370. doi: 10.1016/0002-9149(83)90140-6. [DOI] [PubMed] [Google Scholar]
  6. Berger H. J., Sands M. J., Davies R. A., Wackers F. J., Alexander J., Lachman A. S., Williams B. W., Zaret B. L. Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries. Ann Intern Med. 1981 Feb;94(2):186–191. doi: 10.7326/0003-4819-94-2-186. [DOI] [PubMed] [Google Scholar]
  7. Borer J. S., Brensike J. F., Redwood D. R., Itscoitz S. B., Passamani E. R., Stone N. J., Richardson J. M., Levy R. I., Epstein S. E. Limitations of the electrocardiographic response to exercise in predicting coronary-artery disease. N Engl J Med. 1975 Aug 21;293(8):367–371. doi: 10.1056/NEJM197508212930801. [DOI] [PubMed] [Google Scholar]
  8. Boudoulas H., Cobb T. C., Leighton R. F., Wilt S. M. Myocardial lactate production in patients with angina-like chest pain and angiographically normal coronary arteries and left ventricle. Am J Cardiol. 1974 Oct 3;34(5):501–505. doi: 10.1016/0002-9149(74)90118-0. [DOI] [PubMed] [Google Scholar]
  9. Bruce R. A., Kusumi F., Hosmer D. Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am Heart J. 1973 Apr;85(4):546–562. doi: 10.1016/0002-8703(73)90502-4. [DOI] [PubMed] [Google Scholar]
  10. Chaitman B. R., DeMots H., Bristow J. D., Rösch J., Rahimtoola S. H. Objective and subjective analysis of left ventricular angiograms. Circulation. 1975 Sep;52(3):420–425. doi: 10.1161/01.cir.52.3.420. [DOI] [PubMed] [Google Scholar]
  11. Davies H. A., Jones D. B., Rhodes J. 'Esophageal angina' as the cause of chest pain. JAMA. 1982 Nov 12;248(18):2274–2278. [PubMed] [Google Scholar]
  12. Day L. J., Sowton E. Clinical features and follow-up of patients with angina and normal coronary arteries. Lancet. 1976 Aug 14;2(7981):334–337. doi: 10.1016/s0140-6736(76)92591-5. [DOI] [PubMed] [Google Scholar]
  13. Eliot R. S., Bratt G. The paradox of myocardial ischemia and necrosis in young women with normal coronary anteriograms. Relation to abnormal hemoglobin-oxygen dissociation. Am J Cardiol. 1969 May;23(5):633–638. doi: 10.1016/0002-9149(69)90023-x. [DOI] [PubMed] [Google Scholar]
  14. Hartz A. J., Anderson A. J., Brooks H. L., Manley J. C., Parent G. T., Barboriak J. J. The association of smoking with cardiomyopathy. N Engl J Med. 1984 Nov 8;311(19):1201–1206. doi: 10.1056/NEJM198411083111901. [DOI] [PubMed] [Google Scholar]
  15. Kemp H. G., Jr, Vokonas P. S., Cohn P. F., Gorlin R. The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. Am J Med. 1973 Jun;54(6):735–742. doi: 10.1016/0002-9343(73)90060-0. [DOI] [PubMed] [Google Scholar]
  16. Leighton R. F., Wilt S. M., Lewis R. P. Detection of hypokinesis by a quantitative analysis of left ventricular cineangiograms. Circulation. 1974 Jul;50(1):121–127. doi: 10.1161/01.cir.50.1.121. [DOI] [PubMed] [Google Scholar]
  17. Meller J., Goldsmith S. J., Rudin A., Pichard A. D., Gorlin R., Teichholz L. E., Herman M. V. Spectrum of exercise thallium-201 myocardial perfusion imaging in patients with chest pain and normal coronary angiograms. Am J Cardiol. 1979 Apr;43(4):717–723. doi: 10.1016/0002-9149(79)90069-9. [DOI] [PubMed] [Google Scholar]
  18. Ockene I. S., Shay M. J., Alpert J. S., Weiner B. H., Dalen J. E. Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. N Engl J Med. 1980 Nov 27;303(22):1249–1252. doi: 10.1056/NEJM198011273032201. [DOI] [PubMed] [Google Scholar]
  19. Opherk D., Zebe H., Weihe E., Mall G., Dürr C., Gravert B., Mehmel H. C., Schwarz F., Kübler W. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation. 1981 Apr;63(4):817–825. doi: 10.1161/01.cir.63.4.817. [DOI] [PubMed] [Google Scholar]
  20. Pasternac A., Noble J., Streulens Y., Elie R., Henschke C., Bourassa M. G. Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries. Circulation. 1982 Apr;65(4):778–789. doi: 10.1161/01.cir.65.4.778. [DOI] [PubMed] [Google Scholar]
  21. Pasternak R. C., Thibault G. E., Savoia M., DeSanctis R. W., Hutter A. M., Jr Chest pain with angiographically insignificant coronary arterial obstruction. Clinical presentation and long-term follow-up. Am J Med. 1980 Jun;68(6):813–817. doi: 10.1016/0002-9343(80)90199-0. [DOI] [PubMed] [Google Scholar]
  22. Proudfit W. L., Bruschke V. G., Sones F. M., Jr Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10-year follow-up of 521 patients. Circulation. 1980 Oct;62(4):712–717. doi: 10.1161/01.cir.62.4.712. [DOI] [PubMed] [Google Scholar]
  23. Proudfit W. L., Shirey E. K., Sones F. M., Jr Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. Circulation. 1966 Jun;33(6):901–910. doi: 10.1161/01.cir.33.6.901. [DOI] [PubMed] [Google Scholar]
  24. Rackley C. E. Quantitative evaluation of left ventricular function by radiographic techniques. Circulation. 1976 Dec;54(6):862–879. doi: 10.1161/01.cir.54.6.862. [DOI] [PubMed] [Google Scholar]
  25. Ramsdale D. R., Bennett D. H., Bray C. L., Ward C., Beton D. C., Faragher E. B. Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study. Eur Heart J. 1984 Sep;5(9):716–726. doi: 10.1093/oxfordjournals.eurheartj.a061732. [DOI] [PubMed] [Google Scholar]
  26. Richardson P. J., Livesley B., Oram S., Olsen E. G., Armstrong P. Angina pectoris with normal coronary arteries. Transvenous myocardial biopsy in diagnosis. Lancet. 1974 Sep 21;2(7882):677–680. doi: 10.1016/s0140-6736(74)93260-7. [DOI] [PubMed] [Google Scholar]
  27. Selzer A. Cardiac ischemic pain in patients with normal coronary arteriograms. Am J Med. 1977 Nov;63(5):661–665. doi: 10.1016/0002-9343(77)90149-8. [DOI] [PubMed] [Google Scholar]
  28. Waxler E. B., Kimbiris D., Dreifus L. S. The fate of women with normal coronary arteriograms and chest pain resembling angina pectoris. Am J Cardiol. 1971 Jul;28(1):25–32. doi: 10.1016/0002-9149(71)90030-0. [DOI] [PubMed] [Google Scholar]

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