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PubMed1983

[Reliability of digital subtraction angiocardiography for the evaluation of left ventricular function and physical stress].

The reliability of determinations of left ventricular dimensions from digital subtraction angiocardiographies during exercise using intravenous injection of contrast material was proved in 20 patients. All angiocardiograms could be analyzed qualitatively and quantitatively only by means of the time-interval-difference (TID-) mode. Compared with other mask modes the superiority of the TID-mode results from the close temporal relationship between mask and contrasted frame. Thus, changes in position and brightness of the background structures are small, and left ventricular contours can be determined accurately despite intense respiratory movements. The intra-observer variability of determinations of end-diastolic and end-systolic volumes was +/- 12 ml (i.e. 7.5% of the mean value), corresponding inter-observer variability was +/- 24 ml (i.e. 17% of the mean value), respectively. Intra-observer deviation in determining ejection fraction was 2.8% (i.e. 4.5% of the mean value). The intra-observer variability in determining left ventricular axes was basal +/- 0.40 cm (i.e. 7% of the mean value), equatorial +/- 0.73 cm (i.e. 13% of the mean value) and apical +/- 0.34 cm (i.e. 8% of the mean value). Deviations of corresponding circumferential fiber shortening rates were basal +/- 0.22 s-1 (i.e. 14% of the mean value), equatorial +/- 0.32 s-1 (i.e. 22% of the mean value), and apical +/- 0.18 s-1 (i.e. 13% of the mean value). The results show that left ventricular dimensions can be determined accurately from intravenous angiocardiograms during exercise using digital subtraction angiocardiography.

Adult↗
PubMed1984

[Calcium antagonists in the treatment of ischemic heart disease].

Using clinical and instrumental findings, the therapeutic effectiveness, hemodynamic effects and tolerance of the three nifedipin derivatives adalate (FRG), corinfar (GDR) and fenigidin (USSR) were studied in 51 patients. The data provided by questioning, examinations and bicycle ergometric tests showed an antianginal effect in 68.5% of the patients treated with corinfar and adalate, and in 61% of those given fenigidin. The best response was observed in patients with angina of effort and those with the angiospastic variant of angina pectoris. The drugs were well tolerated and brought about an insignificant decrease in the arterial pressure and the pulse rate attended by no substantial hemodynamic alterations.

Adult↗
PubMed1983

Role of thromboxanes in vasotonic versus vaso-occlusive angina.

We used a validated radioimmunoassay to examine plasma thromboxane B2 (TxB2) levels in 6 consecutive vasotonic angina (VA) patients, 14 patients with fixed, occlusive coronary artery (VO) disease and 9 healthy volunteers. In the latter groups, basal TxB2 release was absent. However, all 6 VA patients showed basal release. In one, sustained levels of up to 12 pmol/ml over 2 months of clinical instability were found. Daily aspirin rendered TxB2 undetectable with clinical improvement. In a second patient, angina coincided with up to 14 pmol/ml of TxB2 in peripheral blood, and myocardial infarction produced still further increases. The 14 VO patients were then studied by rapid atrial pacing to detect TxB2 release coinciding with pacing-induced angina and myocardial lactate production. All demonstrated significant occlusive disease (2.5 critical lesions per patient). Blood was taken simultaneously from coronary sinus (CS) and brachial artery (BA) catheters for lactate and TxB2 analysis before, immediately after and 10 min after pacing-induced ischemia. Lactate extraction fell from 29.3 +/- 3.7 per cent to -21.1 +/- 12.8 per cent to -74.3 +/- 20.3 per cent during pacing (all p less than 0.01) but was normal in 10 min (25.1 +/- 3.55). CS TxB2 rose from 18 per cent to 204 per cent of control during pacing but was absent after 10 min. BA TxB2 rose from 40 per cent to 132 per cent of control during and after pacing, but was absent after 10 min (p less than 0.05). In VA, TxB2 is uniquely, continuously present in peripheral blood and levels rise further during symptomatic intervals and myocardial infarction. In VO, even CS TxB2 is absent at rest, and rises less rapidly than in VA, even during pacing-induced ischemia. Although antiplatelet agent will block all TxB2 release even in VO, their clinical potential seems greatest in VA.

Angina Pectoris↗
PubMed1983

[Must the medical treatment of vasospastic angina be continued indefinitely?].

A subgroup of 22 patients with Prinzmetal angina and a good clinical response to treatment with calcium inhibitors was studied to determine whether the ergonovine provocation test could help decide when to stop treatment. Before treatment, all patients had ST elevation during the ergonovine test which was performed in the coronary care unit. After 9,4 +/- 4,7 months' treatment, all 22 patients were asymptomatic. Their treatment was discontinued and the ergonovine test repeated. Twelve of the 22 patients had no anginal pain or ST segment changes during the test. Without therapy, none of these 12 patients have experienced recurrence of angina during a follow up period of 4,2 +/- 2,9 months. Angina with ST elevation occurred in 7 patients during the ergonovine test, as observed during their initial provocation tests. In 3 other patients, ergonovine induced ST depression in the leads in which ST elevation had been recorded during their initial tests. Treatment was restarted in these 10 patients with positive tests. There were no complications. Spontaneous remissions of symptoms and negative ergonovine tests may be observed in some patients with Prinzmetal angina. Without treatment this group of patients may remain asymptomatic for several months.

Adult↗
PubMed1983

[Strategy of the treatment of vasospastic angina pectoris].

The strategy of treatment in vasospastic angina is mainly based on the results of coronary angiography. In a series of 165 patients with coronary spasm documented by angiography, 51 patients (31 per cent) had angiographically normal arteries and 69 per cent had organic atherosclerotic lesions. Patients with fixed atherosclerotic lesions were divided in two subgroups depending on whether the lesions were operable. The first subgroup (47 cases) comprised patients with operable lesions and coronary spasm. They underwent aorto-coronary bypass associated with a procedure to prevent spasm (plexectomy) (40 cases). Depending on the site of the lesions, some patients with operable lesions may benefit from coronary angioplasty followed by treatment with calcium antagonist drugs. Patients in the second subgroup (67 cases) with inoperable fixed atherosclerotic lesions were treated with calcium antagonists. Betablockers, which may be considered in organic coronary artery disease, are theoretically contra-indicated because of the vasospastic factor. The remaining patients with "angiographically normal" vessels (51 cases) were treated with nitrate derivatives and calcium antagonists. Treatment should be directed to the suppression of the clinical symptoms and, above all, of ECG signs of ischemia as proved by repeated Holter monitoring. The clinical course may also be assessed by repeated provocation tests. Results may depend on the doses and their timing during the 24 hour period. Duration of treatment in patients with angiographically normal vessels has not yet been established. Isolated cardiac denervation may be indicated in these patients who fail to respond to medical treatment (8 cases).

Adult↗
PubMed1983

[The classic anti-anginal agents and molsidomine].

In the face of the recent introduction of beta-blockers and calcium inhibitors, the author examines the role of Amiodarone, Perhexiline and Molsidomine in the treatment of angina pectoris. Amiodarone, introduced in 1967, remains a very useful anti-anginal drug. The beta and alpha-sympathetic inhibition it produces, makes it effective in effort and resting angina. It is particularly useful in anginal patients with arrhythmias as it has a potent anti-arrhythmic effect at all levels. It can be used in patients with bronchial asthma, in elderly patients and in cardiac failure. However, it may give risk to hypo or hyperthyroidism and so, should not be used in patients with a history or thyroid disorders. Perhexiline has been used in France since 1973 and is a second-line drug to be used in cases of intolerance or contraindications to other anti-anginal drugs. It is effective but may cause severe, undesirable hepatic and neurological complications. These side effects are however rare at low doses. Molsidomine, a more recent molecule, has an action similar to that of the nitrate derivatives: it mainly reduces left ventricular preload. It has a slower onset of action than the classical nitrate derivatives but its duration of action seems to be longer; Molsidomine and betablockade can be a useful therapeutic association.

Amiodarone↗
PubMed1983

[Coronary artery spasm. Apropos of 165 cases].

This study comprised 165 cases of coronary artery spasm (147 men and 18 women) with an average age of 49,2 years (range 27 to 73 years). Smoking was a particularly significant risk factor. Symptoms were usually of recent onset (80%) and dominated by attacks of angina pectoris either at rest alone or associated with angina of effort. 14% of cases of spasm were observed during acute myocardial infarction. Some cases presented with syncope due to cardiac arrhytmias. The basal electrocardiogramme was normal in 53% of cases. Exercise stress testing may be normal (30/65 cases) or positive (ST depression recorded in 26/65 cases). In 5 cases, ST elevation was observed. Left ventricular function was usually normal: 115 patients (70%) had organic atherosclerotic lesions, with 1, 2 and 3 vessel disease in 40%, 18% and 22% respectively. Spasm was spontaneous in 24,2% of cases but most commonly provoked by ergometrine. Criteria of spasm only applied to focal spasm and exclused catheter--induced spasm. The most common site of spasm was the right coronary artery (50,3% of cases), followed by the left anterior descending (31% of cases) and left circumflex (10,3% of cases). The outcome of these 165 cases depended on the therapeutic options (surgical treatment in 48 cases). The medium term results were generally good with a low mortality rate and follow up showed that the calcium antagonists provided effective prophylaxis against recurrence of spasm.

Adult↗