The authors identified 160 men and women from all 3,700 patients with anginal pain between 1990 and 1994 who were subsequently found to have normal coronary arteries at diagnostic cardiac catheterization with follow-up to the present (mean follow-up 2.5 years). The group comprised 50 women and 110 men. Mean age was significantly greater in women (53.1 ± 7. 7 vs 47.2 ± 9.2 years, p<0.001). Forty percent of the women but only 10% of the men had a positive exercise test. At follow-up, a larger proportion of patients continue to experience chest pain (95 patients, 59%) of whom 65 patients (41%) continue antianginal therapy. Furthermore one patient suffered a sudden cardiac death and two patients had a nonfatal myocardial infarction. Of patients referred with chest pain, women were more likely to have normal coronary arteries, compared with men. All patients have an excellent prognosis. A large proportion of women had a positive exercise test in the absence of coronary artery disease. On the other hand, morbidity remains high in these patients, despite the reassurance of a normal-appearing coronary arteriogram.
Background: An increasing body of evidence links atrial fibrillation (AF) to the inflammatory state. It has been suggested that increased C‐reactive protein (CRP) levels are associated with greater risk of AF recurrence at short‐ and mid‐term. Objective: We sought to investigate the association between CRP and long‐term risk of AF recurrence. Methods: This was a prospective observational study. We investigated the association between baseline CRP levels and recurrence of AF over a 3‐year follow‐up period after successful electrical cardioversion (EC). A total of 60 patients were studied (mean age: 68.4 ± 7.2 years, 60% men). All patients were receiving amiodarone for sinus rhythm maintenance. We further divided the study population into three tertiles according to the values of baseline CRP (tertile 1: <0.43 mg/dL; tertile 2: 0.43–0.8 mg/dL; tertile 3: >0.8 mg/dL). Results: Overall, 75% of patients relapsed into AF during the 3‐year study period. AF recurrence was significantly lower in the 1st CRP tertile group (P = 0.039). The Kaplan‐Meier survival analysis showed that the rate of AF recurrence was significantly lower in the lowest CRP tertile (log rank; P < 0.001). In a multivariable Cox regression model adjusted for other potential covariates, only CRP (upper two tertiles) was an independent predictor of AF recurrence (heart rate: 6.3, 95% confidence interval: 3.1–12.7, P < 0.001). Conclusions: Our findings suggest that baseline CRP levels before EC have an independent prognostic value in predicting the long‐term risk of AF recurrence.
The presence of complete left bundle branch block (LBBB) in patients with congestive heart failure has been proposed to be a factor that negatively affects left ventricular (LV) systolic function. The aim of this study was to evaluate the relative predictive value of QRS dispersion (QRSD) and QRS duration (QRSd) in relation to systolic performance of the left ventricle. The ejection fraction of 130 consecutive patients with LBBB was evaluated by standard echocardiographic methods, whereas QRSd and QRSD were measured. It was demonstrated that QRSD in patients with complete LBBB is strongly related to LV contractility. We, therefore, suggest that this simple electrocardiographic index may serve as a useful screening test for detection of patients with LV systolic dysfunction. D 2003 Elsevier Ireland Ltd. All rights reserved.
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