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Distribution of left ventricular ejection fraction in angina patients with severe coronary artery disease not amenable to revascularization

Gupta, Shuchita; Pressman, Gregg S.; Morris, D. Lynn; Figueredo, Vincent M.

doi: 10.1097/MCA.0b013e32833bdf53
Pathophysiology and Natural History

Background: As the number of angina patients with severe coronary artery disease not amenable to revascularization increases, new therapies will be developed. How patients with depressed compared to normal left ventricular ejection fraction (LVEF) will respond to new therapies may differ.

Hypothesis: We conducted a retrospective chart review to determine the distribution of LVEF in angina patients with severe coronary artery disease (three-vessel disease with >50% stenosis major epicardial vessels or >50% stenosis left main) not amenable to revascularization.

Methods: Patients underwent cardiac catheterization between 2004 and 2009. LVEF, measured by echocardiography, nuclear-gated imaging or radioventriculography within 6 months of catheterization, was recorded. Demographics, symptoms, risk factors, past myocardial infarction, catheterization results, medications, and the Duke Coronary Artery Jeopardy Score were recorded.

Results: Eight thousand six hundred and ninety-nine patient charts were reviewed; 124 met criteria. There was a continuous, and not bimodal, distribution of LVEF. Fifty-eight patients (47%) in the normal LVEF group were compared to 66 patients (53%) in the abnormal LVEF group (<50%). The two groups were statistically different only with respect to shortness of breath as a presenting symptom and diagnosis of congestive heart failure during index hospitalization. Follow-up mortality was high and did not differ between LVEF groups (35% vs. 34%).

Conclusion: There is a wide distribution of LVEF among angina patients not amenable to revascularization. A novel finding of this study showed that mortality was high regardless of LVEF. As new therapies for angina are developed, attention will need to be paid to how such therapies affect these two patient groups.

Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center, and Jefferson Medical College, Philadelphia, Pennsylvania, USA

Correspondence to Dr Vincent M. Figueredo, MD, Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center, and Jefferson Medical College, 5501 Old York Road, Levy 3232, Philadelphia, PA 19141, USA

Tel: +215 456 8819; fax: +215 456 3533;

e-mail: figueredov@einstein.edu.

Received 16 April 2010 Accepted 7 May 2010

© 2010 Lippincott Williams & Wilkins, Inc.