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Angina With "Normal" Coronary Arteries—Reply
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In Reply: As noted by Dr Reyes and colleagues, a recent study found a strong association between elevated LVEDP at cardiac catheterization and ischemia during exercise testing in 103 patients found to have insignificant coronary artery disease at angiography.1 These data are in keeping with previous work showing microvascular dysfunction and left ventricular impairment during exercise in 26 patients with apparently normal coronary arteries.2 Patients with left ventricular dysfunction in the absence of previous myocardial infarction are a special subgroup and could be regarded as having early cardiomyopathy. In cardiomyopathies, the impact of coronary microvascular dysfunction is often intricately associated with the underlying mechanism of disease, both of which may predispose to deterioration of left ventricular function.3
In considering the cause of this elevated LVEDP and microvascular dysfunction, hypertension is one of the most common conditions leading to left ventricular dysfunction. Microstructural changes of the left ventricular wall with increased . . . [Full Text of this Article]
Raffaele Bugiardini, MD
raffaele.bugiardini@unibo.it
Department of Internal Medicine
Cardio-Angiology and Hepatology
University of Bologna
Bologna, Italy
C. Noel Bairey Merz, MD
Department of Medicine
Division of Cardiology
Cedars-Sinai Medical Center
Los Angeles, Calif
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