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Long-term prognosis of patients with angina-like chest pain and normal coronary angiographic findings
IN
Long-Term Prognosis of Patients Chest Pain and Normal Coronary Findings
CONSULTATION
of the left anterior descending coronary artery. The overall prevalence of myocardial bridges was 0.82% (from 0.41% to 1.16% per year). Among these patients, 26 had coronary artery disease, 4 had valvular heart disease, and 3 had cardiomyopathy. We studied the long-term outcome (11 + 3 years) of the other 28 patients with isolated milking at baseline. Two groups were constituted according to the percentage of systolic reduction of the left anterior descending coronary artery lumen: group A, <50% (15 patients) and group B, ~50% (13 patients). During follow-up, 1 group A patient (cancer) and 2 group B patients (1 cancer and 1 suicide) died. Moreover, 1 group B patient was lost to follow-up. None of the patients sustained a myocardial infarction during follow-up. In group A patients, 71% felt very well or well and 50% had clinical symptoms; 64% took antianginal medications. In group B patients, 50% felt well and 70% had clinical symptoms; 50% took antianginal drugs, The long-term prognosis of isolated myocardial bridges of the left anterior descending coronary artery is good and is independent of the severity of systolic narrowing of internal lumen diameter.
With Angina-Like Angiographic
Paul ll L&en, Klaus Bargheer, Paul Wenzlaff. Department of internal Medicine, Division of Cardiology, Hannover Medical 5chool, Hannover, Germany. J Am Coil Cardiol 1995;25:1013-8.
Objectives:This study analyzes the long-term course of patients with typical angina pectoris or anginalike chest pain and normal coronary angiographic findings. Background: In previous studies of such patients the rate of occurrence of typical coronary events during follow-up has differed widely, depending on the duration of the study and the number of patients. Methods: One hundred seventy-six patients (mean age 48.3 years) who underwent coronary and left ventricular angiography for typical angina or anginalike chest pain were followed up for 5.8 to 15.8 years (median 12.4). By definition, all patients had normal findings on coronary and left ventricular angiograms; exercise test results were positive in 3 1. Results:Fourteen patients (8%) had a coronary event (0.65%/year) after an average of 9.3 years (median 9.2). Two of the 14 died of a coronary event (O.O9%/year), 1 of cardiogenic shock during acute myocardial infarction, 1 suddenly; 4 had a nonfatal myocardial infarction at an average of 8.1 years (median 9.1); 8 had severe angina pectoris after an average of 10.3 years (median 11. l), confirmed by a second angiogram, now with positive findings. Two patients died of a noncoronary cardiac event (chronic car pulmonale due to obstructive lung disease, acute pulmonary embolism), eight of a noncardiac cause, mainly cancer. None of the 31 patients with a positive exercise test result had a coronary event. Patients with a coronary event had significantly more risk factors (hypercholesterolemia, hypertension, cigarette smoking, diabetes type II) than did those without an event (average 2.4/patient vs. 1.3/patient, p
Cardiovascular Problems in Pregnant With the Marfan Syndrome
Uri Elkayam, Enrique Osttzega, Avraham Shotan, Anilkumar tlehra University of Southern California School of Medicine, Los Angeles, CA. Ann Intern Med 1995;123: I I l-22.
Purpose:To review the available information on the diagnostic, prognostic, and therapeutic aspects of cardiac complications in women with the Marfan syndrome during the peripartum period and to develop guidelines for the approach to these patients on the basis of this information. Data Sources: A MEDLINE search and a manual search of bibliographies from reviewed articles. Study Selection and Data Extraction: Articles that reported on pregnancy in patients with the Marfan syndrome or that discussed potentially relevant aspects of the syndrome. Results: Pregnancy in the Marfan syndrome is associated with two primary problems: potential catastrophic aortic dissection and the risk for having a child with the syndrome. The risk for peripartum aortic dissection is especially high in women in whom aortic root dilatation is diagnosed before pregnancy. Gestation seems to be safer in women without preexisting cardiovascular disease; however, an event-free pregnancy cannot be guaranteed. The Marfan syndrome is inherited in an autosomal dominant manner, and the fetus has a 50% risk for inheriting the mutant gene. Conclusions: Women with the syndrome should be counseled before conception about the risks of pregnancy to both mother and fetus. Because preconceptual dilatation of the ascending aorta seems to be an important predictor for aortic dissection, it should be excluded before pregnancy. Transesophageal echocardiogra-
Isolated Myocardial Bridges With Angiographic Milking of the Left Anterior Descending Coronary Artery: A Long-Term Follow-Up Study Vves Juilliere, VCronique Berder, Christine Suty-Selton, Philippe Buffet, Nicolas Danchin, Francois Chenier. Vandoeuwe-les-Nancy, France. Am Heart ] 1995;129:
663-5. Among 7467 consecutive coronary angiograms performed during an 8-year period, 61 patients had a myocardial bridge ACC CURRENT
JOURNAL
Women
REVIEW
51
March/April
1996
Long-Term Prognosis of Patients Chest Pain and Normal Coronary Findings
CONSULTATION
of the left anterior descending coronary artery. The overall prevalence of myocardial bridges was 0.82% (from 0.41% to 1.16% per year). Among these patients, 26 had coronary artery disease, 4 had valvular heart disease, and 3 had cardiomyopathy. We studied the long-term outcome (11 + 3 years) of the other 28 patients with isolated milking at baseline. Two groups were constituted according to the percentage of systolic reduction of the left anterior descending coronary artery lumen: group A, <50% (15 patients) and group B, ~50% (13 patients). During follow-up, 1 group A patient (cancer) and 2 group B patients (1 cancer and 1 suicide) died. Moreover, 1 group B patient was lost to follow-up. None of the patients sustained a myocardial infarction during follow-up. In group A patients, 71% felt very well or well and 50% had clinical symptoms; 64% took antianginal medications. In group B patients, 50% felt well and 70% had clinical symptoms; 50% took antianginal drugs, The long-term prognosis of isolated myocardial bridges of the left anterior descending coronary artery is good and is independent of the severity of systolic narrowing of internal lumen diameter.
With Angina-Like Angiographic
Paul ll L&en, Klaus Bargheer, Paul Wenzlaff. Department of internal Medicine, Division of Cardiology, Hannover Medical 5chool, Hannover, Germany. J Am Coil Cardiol 1995;25:1013-8.
Objectives:This study analyzes the long-term course of patients with typical angina pectoris or anginalike chest pain and normal coronary angiographic findings. Background: In previous studies of such patients the rate of occurrence of typical coronary events during follow-up has differed widely, depending on the duration of the study and the number of patients. Methods: One hundred seventy-six patients (mean age 48.3 years) who underwent coronary and left ventricular angiography for typical angina or anginalike chest pain were followed up for 5.8 to 15.8 years (median 12.4). By definition, all patients had normal findings on coronary and left ventricular angiograms; exercise test results were positive in 3 1. Results:Fourteen patients (8%) had a coronary event (0.65%/year) after an average of 9.3 years (median 9.2). Two of the 14 died of a coronary event (O.O9%/year), 1 of cardiogenic shock during acute myocardial infarction, 1 suddenly; 4 had a nonfatal myocardial infarction at an average of 8.1 years (median 9.1); 8 had severe angina pectoris after an average of 10.3 years (median 11. l), confirmed by a second angiogram, now with positive findings. Two patients died of a noncoronary cardiac event (chronic car pulmonale due to obstructive lung disease, acute pulmonary embolism), eight of a noncardiac cause, mainly cancer. None of the 31 patients with a positive exercise test result had a coronary event. Patients with a coronary event had significantly more risk factors (hypercholesterolemia, hypertension, cigarette smoking, diabetes type II) than did those without an event (average 2.4/patient vs. 1.3/patient, p
Cardiovascular Problems in Pregnant With the Marfan Syndrome
Uri Elkayam, Enrique Osttzega, Avraham Shotan, Anilkumar tlehra University of Southern California School of Medicine, Los Angeles, CA. Ann Intern Med 1995;123: I I l-22.
Purpose:To review the available information on the diagnostic, prognostic, and therapeutic aspects of cardiac complications in women with the Marfan syndrome during the peripartum period and to develop guidelines for the approach to these patients on the basis of this information. Data Sources: A MEDLINE search and a manual search of bibliographies from reviewed articles. Study Selection and Data Extraction: Articles that reported on pregnancy in patients with the Marfan syndrome or that discussed potentially relevant aspects of the syndrome. Results: Pregnancy in the Marfan syndrome is associated with two primary problems: potential catastrophic aortic dissection and the risk for having a child with the syndrome. The risk for peripartum aortic dissection is especially high in women in whom aortic root dilatation is diagnosed before pregnancy. Gestation seems to be safer in women without preexisting cardiovascular disease; however, an event-free pregnancy cannot be guaranteed. The Marfan syndrome is inherited in an autosomal dominant manner, and the fetus has a 50% risk for inheriting the mutant gene. Conclusions: Women with the syndrome should be counseled before conception about the risks of pregnancy to both mother and fetus. Because preconceptual dilatation of the ascending aorta seems to be an important predictor for aortic dissection, it should be excluded before pregnancy. Transesophageal echocardiogra-
Isolated Myocardial Bridges With Angiographic Milking of the Left Anterior Descending Coronary Artery: A Long-Term Follow-Up Study Vves Juilliere, VCronique Berder, Christine Suty-Selton, Philippe Buffet, Nicolas Danchin, Francois Chenier. Vandoeuwe-les-Nancy, France. Am Heart ] 1995;129:
663-5. Among 7467 consecutive coronary angiograms performed during an 8-year period, 61 patients had a myocardial bridge ACC CURRENT
JOURNAL
Women
REVIEW
51
March/April
1996