Four-year follow-up study in patients with angina pectoris and normal coronary arteriograms ("syndrome X")
In patients with typical stress-induced anginal pain, normal coronary arteries, and unimpaired left ventricular performance at rest ("syndrome X"), a reduced coronary dilatory capacity, abnormal lactate metabolism during stress, and reduction of left ventricular functional reserve have been described. A group of 40 patients with syndrome X was followed for several years to determine their long-term prognosis. In 27 patients pulmonary artery pressure and in 19 patients left ventricular ejection fraction were reassessed during rest and exercise approximately 4 years after the initial examination. In patients with stress-induced ST-segment depression, these variables did not change during the observation period. In patients with constant or rate-dependent left bundle branch block, however, there was significant deterioration of left ventricular performance during rest (pulmonary artery mean pressure, 16 +/- 3 vs. 17 +/- 4 mm Hg, p = NS; left ventricular ejection fraction, 62 +/- 5% vs. 55 +/- 5%, p less than 0.05) and exercise (pulmonary artery, 30 +/- 6 vs. 39 +/- 10 mm Hg, p less than 0.005; left ventricular ejection fraction, 59 +/- 6% vs. 49 +/- 5%, p less than 0.01). These findings suggest that in syndrome X two subgroups with distinctly different prognoses may be defined: In patients with stress-induced ST-segment depression during exercise, left ventricular performance remains well preserved; however, in patients with either constant or rate-dependent left bundle branch block, there is significant deterioration of left ventricular function within several years.
Opherk
D
D
Department of Medicine III (Cardiology), Medical Center of the University of Heidelberg, West Germany.
Schuler
G
G
Wetterauer
K
K
Manthey
J
J
Schwarz
F
F
Kübler
W
W
D000787:Angina Pectoris / Q000175:diagnosis* / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000175:diagnosis; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D013577:Syndrome; D013997:Time Factors