Skip Navigation


European Heart Journal Advance Access originally published online on October 6, 2006
European Heart Journal 2006 27(21):2606; doi:10.1093/eurheartj/ehl257
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
27/21/2606    most recent
ehl257v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Skalidis, E. I.
Right arrow Articles by Vardas, P. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Skalidis, E. I.
Right arrow Articles by Vardas, P. E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Guidelines on the management of stable angina pectoris

Emmanuel I. Skalidis

Department of Cardiology
Heraklion University Hospital
PO Box 1352
Stavrakia (Crete) 71110
Heraklion
Greece

Panos E. Vardas

Department of Cardiology
Heraklion University Hospital
PO Box 1352
Stavrakia (Crete) 71110
Heraklion
Greece
Tel: +30 2810 392632
Fax: +30 2810 542111
E-mail address: cardio{at}med.uoc.gr

We read with great interest the recently published guidelines on the management of stable angina pectoris.1

Although we have to congratulate the authors on the superb work they have done, we were surprised to see patients with left bundle branch block classified under Class I indications for exercise stress imaging in the initial diagnostic assessment of angina (level of evidence B), as well as in risk stratification (level of evidence C).

This seems odd, considering the numerous published papers showing not only the limited diagnostic accuracy of exercise2,3 and the improved specificity of pharmacological stress,4–7 but also the possible underlying mechanisms in these patients.7

In view of the above, we suggest that these patients should be reclassified under Class I indications for pharmacological stress imaging, unless there are other relevant data that we have overlooked or are unaware of.

References

  1. Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, Daly C, De Backer G, Hjemdahl P, Lopez-Sendon J, Marco J, Morais J, Pepper J, Sechtem U, Simoons M, Thygesen K, Priori SG, Blanc JJ, Budaj A, Camm J, Dean V, Deckers J, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo J, Zamorano JL. (2006) Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology; ESC Committee for Practice Guidelines (CPG) 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 27:1341–1381.[Free Full Text]
  2. De Puey EG, Guertler-Krawezynska E, Rolbins WL. (1988) Thallium-201 SPECT in coronary artery disease patients with left bundle branch block. J Nucl Med 29:1479–1485.[Abstract/Free Full Text]
  3. Jazmati B, Sadaniantz A, Emaus SP, Heller GV. (1991) Exercise thallium-201 imaging in complete left bundle branch block and the prevalence of septal perfusion defects. Am J Cardiol 67:46–49.[CrossRef][Web of Science][Medline]
  4. Jukema JW, Van der Wall EE, Van der Vis-Melsen MJ, Kruyswijk HH, Bruschke AV. (1993) Dipyridamole thallium-201 scintigraphy for improved detection of stenosis in patients with left bundle branch block. Eur Heart J 14:53–56.[Abstract/Free Full Text]
  5. O'Keefe JH Jr, Bateman TM, Barnhart CS. (1993) Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block. J Am Coll Cardiol 21:1332–1338.[Abstract]
  6. Vaduganathan P, Zuo-Xiang HE, Raghavan C, Mahmarian JJ, Verani MS. (1996) Detection of left anterior descending coronary artery stenosis in patients with left bundle branch block: exercise, adenosine or dobutamine imaging? J Am Coll Cardiol 28:543–550.[Abstract]
  7. Skalidis EI, Kochiadakis GE, Koukouraki SI, Parthenakis FI, Karkavitsas NS, Vardas PE. (1999) Phasic coronary flow pattern and flow reserve in patients with left bundle branch block and normal coronary arteries. J Am Coll Cardiol 33:1338–1346.[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
27/21/2606    most recent
ehl257v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Skalidis, E. I.
Right arrow Articles by Vardas, P. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Skalidis, E. I.
Right arrow Articles by Vardas, P. E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?