[Diagnostic and prognostic aspects of angina pectoris preceding myocardial infarction in long-term follow-up].

AIM: To trace relations of premyocardial infarction (preMI) angina, myocardial reserves and clinical peculiarities within a year of outpatient follow-up.

MATERIAL AND

METHODS

Coronary and myocardial reserves were studied in 320 MI survivors using veloergometry, transesophageal pacing (TEP), 24-h ECG monitoring, echocardiography. Cardiac output reaction to TEP was assessed.

RESULTS

Patients with preMI attacks of stable angina had coronary reserve 47.9% less than they had before MI while cardiac failure by NYHA criteria aggravated by 33.3%. Myocardial ischemia at bicycle exercise in these patients developed much later and its threshold rose by 34.2%. The degree of cardiac ejection fall in TEP in patients without angina before MI was 2.4 times greater than in patients without history of IHD. There were specific features of diastolic relaxation of the myocardium and variability of cardiac rhythm in the compared groups though the groups did not differ significantly by arrhythmia events and morphological characteristics of the scar zone. Survival showed a tendency to lowering of lethal outcome risk in the compared groups followed up since the observation month 6 without significant differences depending on the presence of preMI angina.

CONCLUSION

PreMI angina contributes to formation of coronary and myocardial reserves which are better to assess at TEP and with analysis of hemodynamic reaction to induced rise in heart rate.