Chronic stable angina risk stratification based upon rest left ventricular function: Difference between revisions

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==Overview==
==Overview==
[[Echocardiography]] is the '''best initial tool''' for obtaining an estimate of left ventricular function <ref name="pmid9118558">Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9118558 ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography.] ''Circulation'' 95 (6):1686-744. PMID: [http://pubmed.gov/9118558 9118558]</ref>, both systolic and diastolic. In addition, echocardiography also provides information regarding associated valvular dysfunction and [[pulmonary artery pressure]]s. This information can in turn be used to select or modify the treatment regimen for the patient.
[[Echocardiography]] is the best initial tool for obtaining an estimate of left ventricular function,<ref name="pmid9118558">Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9118558 ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography.] ''Circulation'' 95 (6):1686-744. PMID: [http://pubmed.gov/9118558 9118558]</ref> both systolic and diastolic. In addition, echocardiography also provides information regarding associated valvular dysfunction and pulmonary artery pressures. This information can in turn be used to select or modify the treatment regimen for the patient.


==Indications for assessing Left ventricular function<ref name="pmid9118558">Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9118558 ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography.] ''Circulation'' 95 (6):1686-744. PMID: [http://pubmed.gov/9118558 9118558]</ref>==
==Indications for Assessing Left Ventricular Function<ref name="pmid9118558">Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9118558 ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography.] ''Circulation'' 95 (6):1686-744. PMID: [http://pubmed.gov/9118558 9118558]</ref>==
*Patients with evidence of [[congestive heart failure]],
*Patients with evidence of [[congestive heart failure]]
*Patients with evidence of valvular dysfunction,
*Patients with evidence of valvular dysfunction
*Patients with documented [[MI]],
*Patients with documented [[MI]]
*Patients with an [[ECG]] showing '''Q waves''' (suggestive of an old [[MI]]).
*Patients with an [[ECG]] showing Q waves (suggestive of an old [[MI]])


==Mortality based on Ejection Fraction==
==Mortality Based on Ejection Fraction==
*A resting or exercise LV [[ejection fraction]] ([[LVEF]]) of '''less than 35%''' is associated with a significantly higher mortality than a normal [[LVEF]].
*A resting or exercise LV [[ejection fraction]] ([[LVEF]]) of less than 35% is associated with a significantly higher mortality than a normal [[LVEF]].


*In patients with three-vessel [[coronary artery disease]], the presence of an [[ejection fraction]] of '''less than 50%''' or clinical evidence of [[heart failure]] is associated with almost three times higher mortality than that in patients with normal left ventricular function and a similar extent of [[CAD]]. <ref>{{cite book |last= Braunwald |first= Eugene. |coauthors= Lee Goldman|title= [[Primary Cardiology]]|chapter=25 |publisher= [[Saunders]] |year= 2003|month= April|isbn= 0-7216-9444-6}}</ref>
*In patients with three-vessel [[coronary artery disease]], the presence of an [[ejection fraction]] of less than 50% or clinical evidence of [[heart failure]] is associated with almost three times higher mortality than that in patients with normal left ventricular function and a similar extent of [[CAD]].<ref>{{cite book |last= Braunwald |first= Eugene. |coauthors= Lee Goldman|title= [[Primary Cardiology]]|chapter=25 |publisher= [[Saunders]] |year= 2003|month= April|isbn= 0-7216-9444-6}}</ref>


==ACC / AHA Guidelines- Measurement of Rest LV function by Echocardiography or Radionuclide Angiography (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>==
==ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>==
{{cquote|
===[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]===
'''1.''' [[Chronic stable angina echocardiography|Echocardiography]] or [[Chronic stable angina myocardial perfusion scintigraphy|radionuclide angiography]] (RNA) in patients with a history of prior [[MI]], pathological [[Q waves]], or symptoms or signs suggestive of [[heart failure]] to assess LV function. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''


'''2.''' [[Chronic stable angina echocardiography|Echocardiography]] in patients with a [[systolic murmur]] suggesting [[mitral regurgitation]] to assess its severity and etiology. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''
===Rest LV Function (Echocardiographic/Radionuclide Imaging) (DO NOT EDIT)<ref name="pmid10351980">{{cite journal| author=Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al.| title=ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). | journal=Circulation | year= 1999 | volume= 99 | issue= 21 | pages= 2829-48 | pmid=10351980 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10351980  }} </ref>===


'''3.''' [[Chronic stable angina echocardiography|Echocardiography]] or [[Chronic stable angina myocardial perfusion scintigraphy|radionuclide angiography]] in patients with complex [[ventricular arrhythmia]]s to assess LV function. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]


===[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class III]]===
|-
'''1.''' Routine periodic reassessment of stable patients for whom no new change in therapy is contemplated. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina echocardiography|Echocardiography]] or [[Chronic stable angina myocardial perfusion scintigraphy|radionuclide angiography]] (RNA) in patients with a history of prior [[MI]], pathological [[Q waves]], or symptoms or signs suggestive of [[heart failure]] to assess LV function. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Chronic stable angina echocardiography|Echocardiography]] in patients with a [[systolic murmur]] suggesting [[mitral regurgitation]] to assess its severity and etiology. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Chronic stable angina echocardiography|Echocardiography]] or [[Chronic stable angina myocardial perfusion scintigraphy|radionuclide angiography]] in patients with complex [[ventricular arrhythmia]]s to assess LV function. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


'''2.''' Patients with a [[Chronic stable angina risk stratification electrocardiogram/chest x-ray|normal ECG]], no history of [[MI]], and no symptoms or signs suggestive of [[heart failure]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''}}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
 
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine periodic reassessment of stable patients for whom no new change in therapy is contemplated. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' Patients with a [[Chronic stable angina risk stratification electrocardiogram/chest x-ray|normal ECG]], no history of [[MI]], and no symptoms or signs suggestive of [[heart failure]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|}


==ESC Guidelines- Risk Stratification by Echocardiographic evaluation of Ventricular Function  (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
==ESC Guidelines- Risk Stratification by Echocardiographic evaluation of Ventricular Function  (DO NOT EDIT)<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>==
{{cquote|
===Class I===
'''1.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with prior [[MI]], symptoms or signs of [[heart failure]], or resting ECG abnormalities. ''(Level of Evidence: B)''
'''2.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with [[hypertension]]. ''(Level of Evidence: B)''
'''3.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with [[diabetes]]. ''(Level of Evidence: c)''


===Class IIa===
{|class="wikitable"
'''1.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with a normal [[Chronic stable angina electrocardiography|resting ECG]] without prior [[MI]] who are not otherwise to be considered for coronary arteriography. ''(Level of Evidence: C)''}}
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[European society of cardiology#Classes of Recommendations|Class I]]


==Vote on and Suggest Revisions to the Current Guidelines==
|-
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with prior [[MI]], symptoms or signs of [[heart failure]], or [[Chronic stable angina risk stratification electrocardiogram/chest x-ray|resting ECG]] abnormalities. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with [[hypertension]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with [[diabetes]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


==Sources==
{|class="wikitable"
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref>
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[European society of cardiology#Classes of Recommendations|Class IIa]]


*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367  }} </ref>
|-
 
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Chronic stable angina echocardiography|Resting echocardiography]] in patients with a normal [[Chronic stable angina electrocardiography|resting ECG]] without prior [[MI]] who are not otherwise to be considered for [[Chronic stable angina risk stratification coronary angiography|coronary arteriography]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>
|}
 
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
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Latest revision as of 17:13, 29 January 2013

Chronic stable angina Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Echocardiography is the best initial tool for obtaining an estimate of left ventricular function,[1] both systolic and diastolic. In addition, echocardiography also provides information regarding associated valvular dysfunction and pulmonary artery pressures. This information can in turn be used to select or modify the treatment regimen for the patient.

Indications for Assessing Left Ventricular Function[1]

  • Patients with evidence of congestive heart failure
  • Patients with evidence of valvular dysfunction
  • Patients with documented MI
  • Patients with an ECG showing Q waves (suggestive of an old MI)

Mortality Based on Ejection Fraction

  • A resting or exercise LV ejection fraction (LVEF) of less than 35% is associated with a significantly higher mortality than a normal LVEF.

ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[3]

Rest LV Function (Echocardiographic/Radionuclide Imaging) (DO NOT EDIT)[3]

Class I
"1. Echocardiography or radionuclide angiography (RNA) in patients with a history of prior MI, pathological Q waves, or symptoms or signs suggestive of heart failure to assess LV function. (Level of Evidence: B)"
"2. Echocardiography in patients with a systolic murmur suggesting mitral regurgitation to assess its severity and etiology. (Level of Evidence: C)"
"3. Echocardiography or radionuclide angiography in patients with complex ventricular arrhythmias to assess LV function. (Level of Evidence: B)"
Class III
"1. Routine periodic reassessment of stable patients for whom no new change in therapy is contemplated. (Level of Evidence: C)"
"2. Patients with a normal ECG, no history of MI, and no symptoms or signs suggestive of heart failure. (Level of Evidence: B)"

ESC Guidelines- Risk Stratification by Echocardiographic evaluation of Ventricular Function (DO NOT EDIT)[4]

Class I
"1. Resting echocardiography in patients with prior MI, symptoms or signs of heart failure, or resting ECG abnormalities. (Level of Evidence: B)"
"2. Resting echocardiography in patients with hypertension. (Level of Evidence: B)"
"3. Resting echocardiography in patients with diabetes. (Level of Evidence: C)"
Class IIa
"1. Resting echocardiography in patients with a normal resting ECG without prior MI who are not otherwise to be considered for coronary arteriography. (Level of Evidence: C)"

References

  1. ↑ 1.0 1.1 Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ et al. (1997) ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation 95 (6):1686-744. PMID: 9118558
  2. ↑ Braunwald, Eugene. (2003). "25". Primary Cardiology. Saunders. ISBN 0-7216-9444-6. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM; et al. (1999). "ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina)". Circulation. 99 (21): 2829–48. PMID 10351980.
  4. ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.

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