Chronic stable angina risk stratification based upon rest left ventricular function


 * Associate Editor(s)-in-Chief: ; 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, 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 ==
 * 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.


 * 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.

==ACC / AHA Guidelines- Measurement of Rest LV function by Echocardiography or Radionuclide Angiography (DO NOT EDIT) == {{cquote|

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) == {{cquote|

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)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology


 * The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina