Biomedical subjects

W Voelker

Publications and source records attributed to W Voelker.

At least 55 records · Page 3Linked to original sources

PubMed1994

The effect of LDL apheresis on progression of coronary artery disease in patients with familial hypercholesterolemia. Results of a multicenter LDL apheresis study.

This study investigated the effect of extracorporal lipid-lowering therapy by low-density lipoprotein (LDL) apheresis on coronary artery disease in a population characterized by early development and rapid progression of atherosclerosis. We treated 32 patients aged between 15 and 63 years with drug-refractory familial hypercholesterolemia, treated once a week by immuno-specific LDL apheresis for 3 years in a controlled prospective and non-randomized trial; 25 patients (14 females and 11 males) completed the study. Noninvasive data were obtained by physical examination, 12-lead ECG and exercise testing. Invasive cardiological data were obtained by cardiac catheterization according to a standardized protocol in four cardiological centers. Left ventricular ejection fraction was calculated using planimetry. Coronary stenoses were measured quantitatively in 23 defined coronary segments by a panel of four investigators with an electronic digital caliper. In addition, overall coronary atherosclerosis was visually qualified. Final decisions on a classification into one of three groups (regression, no change, progression) of coronary atherosclerosis were based on panel consensus. Six cardiac events occurred throughout the study: percutaneous transluminal coronary angioplasty in one patient, coronary bypass grafting in three and two deaths. Statistical analysis of exercise testing yielded no significant change for maximum power and work capacity during the study period. Hemodynamic data revealed no significant change; mean ejection fraction was calculated as 65.8 +/- 15.9% at study entry and 67.0 +/- 12.7% at completion. Quantitative measurement of 111 circumscribed coronary stenoses showed a mean stenosis degree of 45 +/- 26% at entry cineangio-film and 43 +/- 22% at final cineangio-film demonstrating no significant change.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Comparative long-term experience with immunoadsorption and dextran sulfate cellulose adsorption for extracorporeal elimination of low-density lipoproteins.

Two low-density lipoprotein (LDL) apheresis methods allowing a specific extracorporeal removal of atherogenic lipoproteins from plasma were compared concerning their efficacy and safety in the long-term therapy of severe familial hypercholesterolemia. Five patients were treated with immunoadsorption (IMA) at weekly intervals over 3 years each, and three patients received weekly therapy with dextran sulfate cellulose adsorption (DSA) for up to 2 years. The mean plasma volume processed per session to decrease total cholesterol to a target level of 100-150 mg/dl at the end of LDL apheresis was significantly lower in DSA than in IMA: 143% vs. 180% of the individual plasma volume. Both LDL apheresis procedures achieved a mean acute reduction of plasma LDL cholesterol by more than 70%. The average interval concentrations of plasma LDL cholesterol obtained without concomitant lipid-lowering medication were 151 +/- 26 mg/dl compared to 351 +/- 65 mg/dl at baseline in the IMA-treated patients and 139 +/- 18 mg/dl compared to 359 +/- 48 mg/dl at baseline in the DSA-treated patients. Two patients from the DSA group died after 2 years of study participation due to a stroke and a sudden cardiac death several days after the last plasma therapy. Treatment-related side effects were infrequent. Long-term therapy with IMA and DSA was associated with symptomatic improvement of coronary artery disease and mobilization of tissue cholesterol deposits. Analysis of coronary angiograms after 3 years of weekly LDL apheresis with IMA revealed in five patients nearly identical atherosclerotic lesions without definite regression or progression.

Adult↗

PubMed1994

[Transvenous sonography of the peripheral arterial vessels. The initial clinical results].

Intravascular ultrasound with 20 MHz/6.2-French transducer systems was used for arterial imaging via a transvenous approach. In 20 patients suffering from chronic arterial occlusive disease, 15 iliac arteries were evaluated during diagnostic angiography and 5 femoropopliteal arteries during balloon angioplasty (n = 3) and laser-assisted angioplasty (n = 2), respectively. Transvenous sonography did not allow differentiation of arterial wall layers and determination of vessel diameters as is usually possible during intraarterial sonography. Visualisation of iliac arteries was incomplete. In femoropopliteal vessels, guide wires could be detected within the arterial lumen but not in complete occlusions. Delivery of pulsed laser energy induced bright echoes near the catheter tip within a distance of 1-2 cm. Transvenous sonography is insufficient for monitoring of peripheral angioplasty; however, improved imaging quality might be possible at lower frequencies.

Aged↗

PubMed1994

Early luminal deterioration following successful percutaneous transluminal coronary angioplasty. Frequency, prediction and clinical implications.

In order to develop a predictive model for the risk of early lesion deterioration following successful coronary balloon angioplasty (PTCA) based on clinical, pre-angioplasty and procedural characteristics, 154 lesions in 146 consecutive patients undergoing successful PTCA for stable/unstable angina were examined by quantitative coronary analysis immediately after and within 24 h of angioplasty. An angiographic complication score was used prospectively, classifying the lesion morphology post-PTCA into class 0: no complication and classes 1 to 3, according to purely descriptive morphological characteristics. Significant deterioration, defined as a decrease in minimal luminal diameter of more than 2 standard deviations of duplicate measurements post-intervention (0.54 mm; 95% confidence limit for variability using quantitative angiography) was found in 28 lesions (18%), and a total reocclusion in seven lesions (5%). The angiographic complication score (P = 0.019), prior to myocardial infarction (P = 0.076), minimal luminal diameter immediately post-intervention (P = 0.021) and gain of PTCA (P = 0.042) were found to be independently predictive of early lesion deterioration by multiple logistic regression analysis. Identification of these factors and their associated risk should improve success, and understanding of the early vascular response following coronary angioplasty. Moreover, these results have implications for clinical restenosis studies, particularly those assessing the effect of pharmacological interventions on late restenosis rates.

Angioplasty, Balloon, Coronary↗

PubMed1994

[Diagnosis of pseudoaneurysm of the ascending aorta after implantation of a valved conduit by multiplane transesophageal echocardiography].

In a 48-year-old male patient with Marfan syndrome who underwent composite graft replacement of the ascending aorta and the aortic valve with reimplantation of the coronary arteries a cardiac enlargement was detected by routine chest x-ray. Transthoracal echocardiography showed a pseudoaneurysm around the composite graft. The examination with a multiplane transesophageal echocardiographic probe demonstrated a systolic-diastolic jet into the pseudoaneurysm with the site of origin at the ostium of the right coronary artery.

Aneurysm, False↗

PubMed1993

Reliability of quantitative coronary angiography of the target lesion immediately and 1 day after coronary balloon and excimer laser angioplasty.

OBJECTIVES: This prospective trial was performed to evaluate the impact of the morphologic complications of angioplasty on the reliability and results of quantitative angiographic assessment of the residual stenosis. BACKGROUND: Postintervention quantitative coronary analysis is limited by a variety of such complications. METHODS: In 199 patients undergoing an early control angiographic study within 24 h after coronary balloon or excimer laser angioplasty (24-h study), detailed quantitative angiographic measurements were performed on the target lesion immediately after intervention and at the 24-h study. Reproducibility of quantitative arteriography was determined by repeat measurements on the same angiogram. RESULTS: Intraobserver/interobserver variability was significantly higher (p < 0.0001/p < 0.03) for the postintervention angiogram than for the 24-h angiogram. Patients were classified into three subgroups with respect to the occurrence of angiographic complications or chest pain after intervention. In patients with angiographic complications after balloon angioplasty alone/stand-alone laser angioplasty/laser angioplasty with adjunctive balloon dilation, a significant difference in mean minimal lumen diameter (p = 0.0001/p = 0.03/p = 0.035) was observed between the immediate postintervention and 24-h angiogram. In patients without angiographic complications or patients with recurrent chest pain undergoing balloon angioplasty, stand-alone or adjunctive laser angioplasty, mean minimal lumen diameter remained nearly unchanged (p = NS). CONCLUSIONS: Angiographic measurements of the target lesion immediately after angioplasty were significantly less reliable than measurements obtained at 24 h after angioplasty in patients with angiographic complications. The occurrence of postintervention vascular complications was associated with significant early lesion changes between the immediate postangioplasty and the 24-h angiogram.

Adult↗

PubMed1993

Comparison of two mechanical ultrasound devices with and without echogenic contrast dye.

To evaluate the impact and limitations of intracoronary ultrasound, 64 segments of 13 isolated coronary arteries were examined and 2 mechanical devices (device A, 30 MHz 5Fr [CVIS] and device B, 20 MHz 4.8Fr [Diasonics/Boston Scientific] were compared with the corresponding histologic specimens. Luminal dimensions were assessed with and without echogenic contrast dye (Laevovist, Schering AG, Germany). After application of contrast dye, correlation of luminal area between histology and ultrasound was improved from r = 0.62 to r = 0.77 (device B; p < 0.05) and from r = 0.82 to r = 0.88 (device A; p = NS). Low accuracy of lumen measurements in segments < 2.5 mm could be improved by application of contrast dye. The number of quadrants in which wall thickness measurements were impossible was significantly higher for device B (n = 56; 22%) than for device A (n = 28; 11%); p < 0.01. This may be due to the different ringdown diameters of both systems (B, 2.6 mm; A, 2.0 mm; p < 0.0001). In assessing wall thickness only in segments of > 2.5 mm, a reliable correlation between ultrasound and histology was found (A, r = 0.80; B, r = 0.60). Sensitivity of plaque (n = 51) detection was lower for device B (63%) than for device A (82%, p < 0.05), and measurements correlated with histology only for device A. There are considerable differences in the accuracy of ultrasound measurements between mechanical systems. Nevertheless, additional application of contrast dye can improve accuracy of luminal measurements, especially in smaller vessels.

Aged↗

PubMed1993

Effect of exercise on valvular resistance in patients with mitral stenosis.

OBJECTIVES: This exercise study assessed the relation between valvular resistance and flow in patients with mitral stenosis. BACKGROUND: Valvular resistance has been proposed as an alternative measure of stenotic valvular lesions, which is speculated to remain stable under changing hemodynamic conditions. METHODS: In 35 of 40 patients with pure or predominant mitral stenosis, continuous wave Doppler measurements of the mitral stenotic jet were possible at rest and during supine bicycle ergometry. Simultaneously, transvalvular flow was assessed by thermodilution technique. For calculation of valvular resistance, the mean mitral valve pressure gradient was determined according to the simplified Bernoulli equation and divided by transvalvular flow. Additionally, effective mitral valve area was calculated according to the continuity equation method, dividing flow by the mean diastolic flow velocity. RESULTS: Valvular resistance was 65 +/- 32 dynes.s.cm-5 at rest and increased to 82 +/- 43 dynes.s.cm-5 at 25 W (p < 0.001). The most prominent increase in valvular resistance (rest to 25 W 63 +/- 28 to 95 +/- 48 dynes.s.cm-5, p < 0.001) was found in those patients who had no or only a moderate (< 20%) change in effective mitral valve area. In contrast, valvular resistance remained constant (67 +/- 36 vs. 70 +/- 32 dynes.s.cm-5) in patients with a significant (> or = 20%) increase in mitral valve area with exercise. CONCLUSIONS: In patients with mitral stenosis, the exercise-induced changes in valvular resistance are heterogeneous. This is the result of the variable response of mitral valve area to an increase in flow. In the individual patient, mitral valve area can significantly increase, a factor that has to be taken into account when interpreting the hemodynamic relevance of the obstruction. Calculated valvular resistance is flow dependent and has no advantage over valve area calculations for quantifying mitral stenosis.

Adult↗

PubMed1993

Acute closure during coronary excimer laser angioplasty and conventional balloon dilatation: a comparison of management outcome and prediction.

Of 523 consecutive patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA) and 83 patients treated with coronary excimer laser angioplasty (ELCA), 17 (3.3%) had in-laboratory occlusion following PTCA and 25 (30%) following ELCA; they were enrolled into a prospective study. Successful management (reopened vessel, patency at repeat angiography within 24 h, no death, no myocardial infarction (MI), no emergency bypass surgery) including repeat lasing, subsequent PTCA, use of intracoronary nitroglycerin or streptokinase was achieved in 24 (96%) of the 25 patients with acute occlusion during ELCA. An anterior MI occurred in one patient of the laser group. Repeat balloon dilatation was successfully performed in seven of the 17 patients (41%) with acute closure during PTCA. Among the 10 patients with persistent occlusion after PTCA, five developed a limited myocardial infarction (35%). One patient required emergency CABG, and died peri-operatively. Severe spasm prior to occlusion defined by a new coronary flow depression without evidence of dissection or thrombus showed a significant positive association with acute occlusion during ELCA (P = 0.0008). Thus, in contrast to occlusion during PTCA, subsequent balloon dilatation was successfully performed in the majority of patients with acute occlusion during ELCA, implying that different underlying mechanisms are responsible for this complication. In this limited patient group, occlusion after excimer laser angioplasty was much more frequent than closure during PTCA, but was infrequently associated with major events such as myocardial infarction or death.

Acute Disease↗

PubMed1993

First clinical experience with low molecular weight heparin LU 47311 (reviparin) for prevention of restenosis after percutaneous transluminal coronary angioplasty.

Restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a major problem limiting the clinical efficacy of the procedure. It has been shown that SMC proliferation plays a predominant role in this accelerated atherosclerotic process. In vitro and in vivo experiments with the LMWH reviparin (LU 47311) suggest a pronounced inhibitory effect of this compound on SMC proliferation. To evaluate the safety of reviparin and the incidence of angiographic restenosis in humans a study with increasing dosages was conducted in 41 patients. Repeat coronary angiography was performed 3 months after angioplasty. Restenosis occurred in 5 of 37 evaluable patients (14%) with initially successful PTCA. No major bleeding complication was documented for any of the patients included in this trial. Thus, in this limited series, administration of LU 47311 (reviparin) resulted in a low incidence of restenosis following PTCA without causing major bleeding complications. A randomized trial in a larger population is warranted to define the real impact of this compound for reduction of restenosis in patients who underwent successful balloon angioplasty.

Adult↗

PubMed1993

[Comparison of the cardiodepressive effects of nifedipine, isradipine, nisoldipine and felodipine in patients with coronary heart disease].

To compare the negative inotropic effects of the four dihydropyridine-calcium-channel-blockers nifedipine (NIF), isradipine (ISR), nisoldipine (NIS) and felodipine (FEL) in man, the drugs were infused within 30 min intravenously in an equihypotensive dosage (NIF 2 mg, ISR 0.5 mg, NIS 0.5 mg, FEL 0.6 mg; 10 patients in each group) in patients with coronary heart disease. As a control, an additional 10 patients received isotonic saline solution following an identical protocol. The afterload reduction was submaximal (reduction of peripheral resistance: NIF -23 +/- 9%, ISR -24 +/- 10%, NIS -28 +/- 6%, FEL -27 +/- 6%; no significant difference for group comparison) with a similar kinetic and a steady state of the afterload reduction after one-half of the infusion period to achieve a comparable sympathetic reflex activation. Preload parameters (PAP, LVEDP) were unchanged in all groups. A reflex tachycardia occurred in all treatment groups after 15 min of drug infusion. Due to its negative chronotropic properties, the reflex tachycardia was significantly attenuated after isradipine as compared to the other drugs (heart-rate changes: NIF +13 +/- 7%, p < 0.01; ISR +4 +/- 7%, not significant; NIS +20 +/- 10%, p < 0.01; FEL +17 +/- 12%, p < 0.01). Because of the baroreflex and sympathetic reflex activation the left-ventricular dp/dtmax increased after isradipine (+14 +/- 10%, p < 0.01) and nisoldipine (+16 +/- 13%, p < 0.01). The lack of a significant dp/dtmax increase in spite of a comparable afterload reduction after felodipine (+5 +/- 8%, not significant) or nifedipine (-3 +/- 6%, not significant) must be a consequence of the cardiodepressive properties of these drugs. Therefore, in an equihypotensive dosage, the strongest negative inotropic effects were observed after nifedipine, lesser effects after felodipine (p < 0.03), and the weakest cardiodepressive effects after isradipine (p < 0.01) and nisoldipine (p < 0.01). For clinical applications the lesser cardiodepressive properties of the new dihydropyridine-derivatives should be advantageous in patients with already reduced left-ventricular performance or for use in combination with other negative inotropic drugs, e.g., betablockers.

Adult↗

PubMed1992

Case report: formation of vessel aneurysm after stand alone coronary excimer laser angioplasty.

Formation of aneurysms in coronary arteries can be observed following percutaneous transluminal balloon angioplasty but has not been reported previously after coronary excimer laser angioplasty in humans. Stand alone coronary excimer laser angioplasty was performed in a 49-year-old man with a 75% left anterior descending artery stenotic lesion and exertional angina, documenting a good angiographic result postintervention. Control angiography 6 months after the procedure revealed an aneurysm distal to a 90% restenosis in the area of ablation.

Angioplasty, Laser↗

PubMed1992

Pressure recovery in aortic stenosis: an in vitro study in a pulsatile flow model.

OBJECTIVES: This study was designed to study pressure recovery in various models of aortic valve stenosis by performing hemodynamic measurements under physiologic conditions in a pulsatile aortic flow circuit. The results were used to validate calculations of pressure recovery based on theoretic considerations derived from fluid dynamics. BACKGROUND: Pressure recovery in aortic stenosis has not been systematically analyzed. METHODS: Stenoses varying in size, shape (circular, Y-shaped, slitlike) and inlet configuration (sharp-edged, nozzle-shaped inlet, artificially stenosed bioprostheses) were used. Aortic pressures were measured at multiple sites distal to the stenotic orifice to determine pressure gradients and recovery. RESULTS: With decreasing orifice area (2, 1.5, 1 and 0.5 cm2) pressure recovery increased (5, 7, 10 and 16 mm Hg, respectively) and the index pressure recovery to maximal peak to peak gradient decreased (56%, 37%, 24% and 14%, respectively). For a given orifice size of 0.5 cm2, this index ranged between 12% for a Y-shaped orifice and 15% for a circular orifice with a nozzle (cardiac output 4 liters/min). Increasing the cardiac output increased pressure recovery, whereas the ratio of pressure recovery to maximal pressure gradient remained constant. CONCLUSIONS: The index pressure recovery to transvalvular pressure gradient, which expresses the hemodynamic relevance of pressure recovery, decreases with increasing severity of aortic stenosis but is independent of transvalvular flow. Thus, pressure recovery is of minor importance in severe aortic stenosis but may account for discrepancies between Doppler and manometric gradients observed in patients with mild to moderate aortic stenosis or a prosthetic valve in the aortic position.

Aortic Valve Stenosis↗

PubMed1992

Effect of heart rate on transmitral flow velocity profile and Doppler measurements of mitral valve area in patients with mitral stenosis.

To study the effect of heart rate changes on Doppler measurements of mitral valve area atrial pacing was performed in 14 patients with mitral stenosis and sinus rhythm. Continuous wave Doppler and haemodynamic measurements were performed simultaneously at rest and during pacing-induced tachycardia. (1) Mitral valve area was determined using the conventional pressure half time method. (2) Additionally, mitral valve area was calculated with a combined Doppler and thermodilution technique according to the continuity equation. (3) Simultaneous invasive measurements were used for calculation of the mitral valve area according to the Gorlin formula. With increasing heart rate (69 +/- 13-97 +/- 15-114 +/- 13 beats min-1) mitral valve area either determined by the continuity equation (1.0 +/- 0.2-1.0 +/- 0.3-1.1 +/- 0.4 cm2) or the Gorlin formula (1.2 +/- 0.3-1.2 +/- 0.4-1.3 +/- 0.4 cm2) remained constant. Both methods correlated closely not only at rest (r = 0.88, SEE = 0.11 cm2, P less than 0.001), but also during atrial pacing (first level: r = 0.95, SEE = 0.10 cm2, P less than 0.001, second level: r = 0.95, SEE = 0.13 cm2, P less than 0.001). In contrast, mitral valve area calculated according to the pressure half time method increased significantly during atrial pacing (1.0 +/- 0.3-1.8 +/- 0.5-2.0 +/- 0.5 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Success rate and incidence of restenosis following coronary excimer laser angioplasty: results of a single center experience.

The initial single center experience of percutaneous coronary excimer laser angioplasty is described for the first three series of 147 patients. Sixty patients were treated with a prototype 1.4-mm laser catheter, 40 patients with improved transmission devices, and the third series of 47 patients with an increased pulse width of the laser system allowing improved energy transmission. In 17 patients (12%) laser angioplasty could not be initiated due to inability to cross the lesion with the guidewire or to place the catheter coaxially within the vessel. In 32 patients (58%) of series 1, 11 patients (31%) of series 2, and 17 patients (43%) of series 3, additional balloon dilatation following laser treatment was necessary due to vessel closure (24%) or due to an insufficient angiographic result (35%). There was one death in series 1 (2%) and 2 (3%) each, one perforation in series 2 (3%), two transmural myocardial infarctions in series 1 (4%), and one myocardial infarction in series 2 (3%). During the 6-month follow-up period one patient in series 2 (2%), and one patient in series 3 (3%) died. Angiographic restenosis was found in 22, 12, and 11 patients of series 1 (40%), 2 (34%), and 3 (27%), respectively. No patient developed a transmural myocardial infarction. Thus, percutaneous coronary excimer laser angioplasty can be performed as a safe and feasible procedure in patients with coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

[Acute and long-term results of coronary Excimer laser angioplasty].

Laser and catheter technology have been considerably improved within the first 2 years of the clinical use of coronary excimer laser angioplasty. Furthermore, patient selection has changed due to increasing operator experience. We report on the acute- and long-term results achieved in 163 patients in three subgroups with different system parameters and catheter technology. In the initial series 1 (N:60) a prototype catheter with a diameter of 1.4 mm was used. In series 2 and 3, we employed improved transmission devices with 1.3, 1.5 or 1.8 mm. In series 3 the pulsewidth was increased from 60 ns to 115 ns. The target vessel was the LAD in 68%, the LCX in 10%, and the RCA in 21%. According to the AHA/ACC Lesion classification there were 13% type A, 26% type B1, 55% type B2, and 5% type C lesions. Stand-alone laser angioplasty was performed in 23/60 (38%), 24/40 (60%), and 34/64 (53%) in series 1, 2, and 3, respectively. Additional balloon angioplasty was necessary in 32, 11, and 21 interventions. Failure of laser angioplasty occurred in five patients of series 1 and 2, and nine patients of series 3. Frequently observed complications included coronary spasm in 18 to 32%, dissections in 16% to 33%, and vessel closure in 18 to 27%. Myocardial infarction occurred in three patients in the first and one patient of the second and third series. There was one in-hospital death in series 1 and 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Laser↗

PubMed1991

Value of a modified continuity equation method to quantify mitral valve area in patients with mitral stenosis and sinus rhythm.

To quantify valve area in mitral stenosis, a modified continuity equation method using continuous wave Doppler and thermodilution measurements was applied. In 14 patients with mitral stenosis and sinus rhythm (age: 49 +/- 11 years), transmitral flow velocity was recorded by continuous wave Doppler during right and left heart catheterization. Mitral valve area was calculated by three different methods: 1. According to the continuity equation, stroke volume (thermodilution technique) was divided by the registered time velocity integral of the mitral stenotic jet (continuous wave Doppler). 2. Mitral valve area was calculated by the pressure half-time method. 3. Simultaneous pulmonary capillary wedge and left ventricular pressure measurements were used for determination of mitral valve area according to the Gorlin formula. The mitral valve area determined by application of the continuity equation (y) showed a close correlation to the valve area calculated by the Gorlin equation (x): y = 0.73x + 0.12, SEE = 0.11 cm2, r = 0.88, P less than 0.001. In contrast, the correlation between mitral valve area determined by pressure half-time (y) and the Gorlin formula (x) was not as good: y = 0.77x + 0.11, SEE = 0.26 cm2, r = 0.65, P less than 0.05. Thus, the continuity equation method using combined continuous wave Doppler and thermodilution technique allows a valid determination of mitral valve area. In patients with mitral stenosis and sinus rhythm, this technique is superior to the noninvasive determination of mitral valve area by the conventional pressure half-time method.

Adult↗

PubMed1991

Long-term clinical course of patients with angina and angiographically normal coronary arteries.

In 88 of 103 consecutive patients with angina and normal coronary arteries, follow-up data could be achieved 6-11 years (9.2 +/- 1.2 years) after diagnostic left heart catheterization. Three of these patients died during follow-up (two noncardiac deaths and one death with no identifiable etiology). One patient suffered a documented myocardial infarction. In 40 patients (47%) chest pain diminished, while symptoms were unchanged in 20 (24%) or even worse in 25 (29%). Resolution or persistence of chest pain could not be predicted either by the character of pain (typical vs. atypical), the presence of hypertension, a left bundle-branch block, a positive exercise electrocardiogram or pathological pulmonary artery pressures during exercise, documentation of myocardial bridges, local wall motion abnormalities, or a left ventricular end-diastolic pressure greater than or equal to 13 mmHg. However, continuing chest pain was significantly more common in patients who revealed a 'slow-flow phenomenon' at initial coronary arteriogram. Thus, in patients with angina and normal coronary arteries the long-term course regarding frequency of morbid cardiac events is benign. However, more than half of the patients reported chest pain to be similar or even worse than at catheterization. Most clinical and invasive results at initial evaluation had no predictive value for the persistence of symptoms. The impact of 'slow-flow' in coronary arteriography, which was a phenomenon almost exclusive to patients with constant or even worse chest pain at follow-up, should be evaluated in larger patient populations.

Adult↗