Left ventricular dysfunction secondary to ischemia in women with angina and normal coronary angiograms.
BACKGROUND
Microvascular disease is proposed as a cause of segmental myocardial blood flow abnormalities and heterogeneous myocardial perfusion in cardiac syndrome X.


OBJECTIVE
To assess if myocardial ischemia can be evidenced through both perfusion abnormalities and poststress left ventricular ejection fraction (LVEF) reduction by gated single photon emission tomography (SPECT) myocardial scintigraphy in women with syndrome X in a similar way to those with epicardial coronary lesions.


METHODS
Three groups of postmenopausal women were studied: group I, 20 women with angina, perfusion defects, and normal coronary angiography; group II, 20 women with epicardial coronary lesions (> or =50% of coronary lumen reduction); group III, 15 volunteers without signs or symptoms of ischemia (control group). Each underwent technetium-99m ((99m)TC) methoxyisobutylisonitrile gated SPECT myocardial scintigraphy (protocol: exercise-stress-rest), brachial artery endothelial function measured by ultrasonography, and lipidogram.


RESULTS
Groups I and III patients had a higher body mass index (BMI). There were more smokers in groups I and II. Very low density lipoprotein cholesterol (VLDL-C) and triglycerides were higher in group II patients. The brachial artery vasodilator responsiveness after 5 minutes of ischemia was similarly lower in patients of groups I and II compared with those of group III (3% vs. 6.5%, respectively; p = 0.03 group III vs. group I and group II). Mean DeltaLVEF (LVEF poststress minus LVEF at rest) was -3.86%, -2.90%, and 4.18% in groups I, II, and III, respectively (p = NS between I and II, p = 0.005 between II and III, and p = 0.003 between I and III). In 43% of group I patients and in 10 of 18 group III patients with perfusion defects, there was a poststress LVEF reduction >5%.


CONCLUSIONS
Stress-induced ischemia is associated with poststress LVEF reduction as a probable manifestation of myocardial stunning in postmenopausal women with typical angina and normal coronary angiography.
Peix
Amalia
A
Institute of Cardiology, La Habana, Cuba. peix@infomed.sld.cu
González
Aníbal
A
García
Ernesto J
EJ
Valiente
Juan
J
Cabrera
Lázaro O
LO
Sixto
Sherien
S
Filgueiras
César E
CE
Cabalé
Beatriz
B
Hechavarría
Sheila
S
González
Iovank
I
Carrillo
Regla
R
García-Barreto
David
D
D000328:Adult; D017677:Age Distribution; D000787:Angina Pectoris / Q000150:complications; D015992:Body Mass Index; D017023:Coronary Angiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D017566:Microvascular Angina; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis; D055414:Myocardial Perfusion Imaging; D017698:Postmenopause; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology*