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.
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Article info
Publication history
Published online: March 01, 2016
Accepted:
February 23,
2016
Received in revised form:
February 23,
2016
Received:
December 21,
2015
Footnotes
See page 1561 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
