ABSTRACT
Variant (Prinzmetal's) angina pectoris is a clinical syndrome characterized by the presence of angina at rest, coinciding with a transient ST-segment elevation. This syndrome is often caused by vasospasm, either on a normal coronary artery or at the site of a coronary atherosclerotic stenosis. We describe a classic case of variant angina associated with an angiosarcoma of the right heart chambers.
Subject(s)
Angina Pectoris, Variant/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Hemangiosarcoma/diagnostic imaging , Angina Pectoris, Variant/diagnosis , Angina Pectoris, Variant/pathology , Heart Atria/diagnostic imaging , Heart Atria/pathology , Heart Neoplasms/diagnosis , Heart Neoplasms/pathology , Hemangiosarcoma/diagnosis , Hemangiosarcoma/pathology , Humans , Magnetic Resonance Spectroscopy , Male , Middle Aged , UltrasonographyABSTRACT
INTRODUCTION AND OBJECTIVES: About 25% of patients with obstructive hypertrophic cardiomyopathy (HCM) remain symptomatic despite optimal medical treatment. Some may benefit from pacemaker implantation. The aim of this study was to determine the effect of pacemaker implantation on the left ventricular outflow tract (LVOT) gradient, the maximum thickness of the left ventricle, and functional capacity. METHODS: In total, 72 patients with obstructive HCM and incapacitating symptoms underwent pacemaker implantation. Clinical examination, echocardiography (in 61 patients) and treadmill testing (in 34 patients) were performed before and after implantation. RESULTS: Subjective functional capacity, as assessed using the New York Heart Association (NYHA) classification, improved in 43.1% of patients, but treadmill testing showed no change. There were significant reductions in subaortic gradient, from a median of 87.0 mmHg (interquartile range [IQR] 61.5-115.2 mmHg) to 30.0 mmHg (IQR 18.0-54.5 mmHg; P< .001), and maximum left ventricular thickness, from 22.1+/-4.5 mm to 19.8+/-3.6 mm (P=.001). Univariate analysis identified two factors associated with clinical improvement: female sex (odds ratio [OR]=3.43; P=.020) and functional class III/IV (OR=4.17; P=.009). On multivariate analysis, only functional class III/IV remained a significant predictor (OR=3.12; P=.048). CONCLUSIONS: In patients with obstructive HCM and incapacitating symptoms, pacemaker implantation reduced the LVOT gradient and the maximum left ventricular thickness, but only 43.1% of patients experienced clinical improvement. The only factor predictive of improvement was advanced NYHA functional class.
