title: Long-Term Preservation of Left Ventricular Systolic Function in Patients With Refractory Angina Pectoris and Inducible Myocardial Ischemia on Optimal Medical Therapy.
abstract: Refractory angina pectoris (RAP) represents a clinical condition characterized by frequent episodes of chest pain despite therapy optimization. According to myocardial stunning and myocardial hibernation definitions, RAP should represent the ideal condition for systolic dysfunction development. We aim to investigate the evolution of left ventricular (LV) function in patients with RAP. A retrospective study which encompasses 144 patients with RAP referred to our institution from 1999 to December 2014 was performed. Of them, 88 met the inclusion criteria, and LV function was assessed by echocardiography. All of them had persistent angina episodes on top of optimal medical therapy and evidence of significant inducible myocardial ischemia and no further revascularization options. Nitrates consumption rate, time of angina duration, and the number of angina attacks were evaluated. In the whole population, ejection fraction (EF) was 44% ± 2. EF was significantly lower in patients with previous myocardial infarction (41% ± 1.5 vs 51% ± 1.8, p <0.0001). The duration time and the number of angina attacks did not correlate with EF in the whole population and in patients without previous myocardial infarction. In patients with previous myocardial infarction, the number of anginal attacks did not correlate with EF, but EF appeared higher in patients with angina duration >5 years (<5 years EF 37% ± 1 [n = 26]; >5 years 44% ± 2 [n = 44]; p 0.02). Long-term LV function in patients with RAP is generally preserved. A previous history of myocardial infarction is the only determinant in the development of systolic dysfunction. In conclusion, frequent angina attacks and a long-term history of angina are not apparently associated to worse LV function.
authors.affiliation: Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy. Electronic address: slavich.massimo@hsr.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Slavich
authors.affiliation: Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maranta
authors.affiliation: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fumero
authors.affiliation: Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.affiliation: Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Oppizzi
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Fragasso
authors.affiliation: Division of Cardiology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001552:Benzazepines / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077550:Ivabradine; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D000069458:Ranolazine / Q000627:therapeutic use; D012189:Retrospective Studies; D026941:Sodium Channel Blockers / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D013599:Systole; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014292:Trimetazidine / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D026941:Sodium Channel Blockers; D014665:Vasodilator Agents; D000077550:Ivabradine; D000069458:Ranolazine; D014292:Trimetazidine