Abnormal Cardiac Adrenergic Nerve Function in Patients With Syndrome X Detected By [
            <sup>123</sup>
            I]Metaiodobenzylguanidine Myocardial Scintigraphy

Lanza, Gaetano Antonio; Giordano, Alessandro; Pristipino, Christian; Calcagni, Maria Lucia; Meduri, G; Trani, Carlo; Franceschini, R; Crea, Filippo; Troncone, L; Maseri, Attilio

doi:10.1161/01.cir.96.3.821

Cited by 141 publications

(103 citation statements)

References 33 publications

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“…40 Of note, pathological cardiac conditions associated with sympathetic hyperactivity such as Takotsubo syndrome or cardiac syndrome X are highly prevalent in postmenopausal women. 41,42 However, whether higher regional cardiac sympathetic activity drives the adaption for a heart of smaller dimensions in elderly women warrants further investigation. There are limitations to this study that should be pointed out.…”

Section: Discussionmentioning

confidence: 99%

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Gebhard

Buechel

Stähli

et al. 2016

European Heart Journal - Cardiovascular Imaging

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BackgroundLeft ventricular (LV) volumetric and functional parameters measured with cardiac computed tomography (cardiac CT) augment risk prediction and discrimination for future mortality. Gender-and age-specific standard values for LV dimensions and systolic function obtained by 64-slice cardiac CT are lacking. Methods and results1155 patients from the Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry (54.5% males, mean age 53.1 + 12.4 years, range: 18 -92 years) without known coronary artery disease (CAD), structural heart disease, diabetes, or hypertension who underwent cardiac CT for various indications were categorized according to age and sex. A cardiac CT data acquisition protocol was used that allowed volumetric measuring of LV function. Image interpretation was performed at each site. Patients with significant CAD (.50% stenosis) on cardiac CT were excluded from the analysis. Overall, mean left ventricular ejection fraction (LVEF) was higher in women when compared with men (66.6 + 7.7% vs. 64.6 + 8.1%, P , 0.001). This gender-difference in overall LVEF was caused by a significantly higher LVEF in women ≥70 years when compared with men ≥70 years (69.95 + 8.89% vs. 65.50 + 9.42%, P ¼ 0.004). Accordingly, a significant increase in LVEF was observed with age (P ¼ 0.005 for males and P , 0.001 for females), which was more pronounced in females (5.21%) than in males

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Section: Discussionmentioning

confidence: 99%

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Gebhard

Buechel

Stähli

et al. 2016

European Heart Journal - Cardiovascular Imaging

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“…The causal, pathogenetic mechanisms of these two particular forms of angina are still largely unknown. Some potentially pathogenetic abnormalities, however, have been suggested to be present in both cases, including increased adrenergic function, 18,19 endothelial dysfunction, 20,21 and elevated endothelin-1 levels. 22 -24 Thus, it is possible that in our patients the same pathogenetic factors might have induced significant functional alterations in conductive and resistance coronary artery vessels.…”

Section: Discussionmentioning

confidence: 99%

Combination of Variant and Microvascular Angina

Infusino

Lanza

Sestito

et al. 2009

Clinical Cardiology

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Prinzmetal's variant angina (VA) and cardiac syndrome X (CSX) are two distinct, usually easily recognizable, forms of angina syndromes, caused by epicardial spasm, usually responsible for transient transmural myocardial ischemia at rest and by coronary microvascular dysfunction (CMVD), usually responsible for effort induced subendocardial ischemia, respectively. In this article we report clinical evidence in three patients of the simultaneous occurrence of angina episodes typical of both VA and CSX, suggesting that common pathogenetic factors may be responsible for clinical manifestations both of functional macrovascular and microvascular coronary artery abnormalities in some angina patients. Copyright © 2009 Wiley Periodicals, Inc.

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“…Studies using myocardial-perfusion MRI 12 and 31-Phosphorus nuclear magnetic resonance 13 have provided fresh evidence for myocardial ischemia in CSX patients. Because many authors question the role of myocardial ischemia in CSX based on its good prognosis, the poor response to nitrates in many cases, the normal results of stress echocardiography, and the absence of objective markers of ischemia in many CSX patients, non-ischemic mechanisms have been proposed to explain the occurrence of CSX, including autonomic nervous system dysfunction 14,15 and increased pain perception. 16 Negative findings regarding ischemia, however, may be due to dilution of study groups by subjects with non-cardiac chest pain and to poor sensitivity of diagnostic techniques.…”

Section: Myocardial Ischemiamentioning

confidence: 99%

Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X)

2004

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P atients with cardiac syndrome X (CSX)-typical chest pain and electrocardiographic changes suggestive of myocardial ischemia despite normal coronary arteriograms-represent a diagnostic and therapeutic riddle. CSX is not associated with an increased mortality or an increased risk of cardiovascular events, but it often severely impairs quality of life and represents a substantial cost burden to the healthcare system. This syndrome of chest pain with normal coronary arteries encompasses a variety of pathogenic subgroups and is predominantly seen in postmenopausal women. Lack of understanding of the syndrome by the cardiovascular physician not infrequently results in discounting the clinical problem. Treatment remains elusive, but management strategies can improve the patient's quality of life and reduce the financial burden imposed on health services.Case Report: A 55-year-old white female pharmacist underwent diagnostic coronary arteriography for the assessment of typical exertional chest pain, which had started 18 months previously and had gradually become more frequent and severe despite treatment with oral and sublingual nitrates and atenolol (50 mg daily). Central chest pain and dyspnea occurred at rest and with emotional stress and responded rather poorly to sublingual nitrate administration. ECG exercise stress test was positive (Figure 1), and transient perfusion defects were found on thallium-201 dipyridamole testing ( Figure 2). She had long-lasting excruciating chest pain after dipyridamole infusion. Risk factors included a family history of coronary artery disease, a lowdensity lipoprotein-cholesterol level of 4.2 mmol/L, a high-density lipoproteincholesterol level 0.9 mmol/L, menopausal status, a previous history of smoking, body-mass index of 28 kg/m 2 , and raised high-sensitivity C-reactive protein levels (3.8 mg/L). Coronary arteries and left ventricular function were completely normal. Coronary intravascular ultrasound showed no significant subangiographic disease. After reassurance by her cardiologist, all cardiac medications were discontinued. Symptoms continued to deteriorate over the ensuing months, however, to the point that she was unable to work and required help with her supermarket shopping and household tasks. She was referred to our CSX clinic for treatment.Esophageal manometry and pH measurements showed 4 asymptomatic episodes of gastroesophageal reflux without associated ECG changes. Specialist psychological assessment revealed no abnormalities. Coronary artery spasm and musculoskeletal conditions were ruled out as the cause of her symptoms. Transient ST-segment depression and chest pain detected during ambulatory monitoring were usually associated with tachycardia ( Figure 3). It was noted that 20% of the episodes of ST-segment depression occurred with a heart rate Ͻ80 bpm. Brachial artery flow-mediated dilatation was reduced to 1.3%, indicating systemic endothelial dysfunction. Dobutamine stressechocardiogram showed no regional wall motion abnormalities despite the occurrence of ST...

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Abnormal Cardiac Adrenergic Nerve Function in Patients With Syndrome X Detected By [ ¹²³ I]Metaiodobenzylguanidine Myocardial Scintigraphy

Cited by 141 publications

References 33 publications

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Combination of Variant and Microvascular Angina

Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X)

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Abnormal Cardiac Adrenergic Nerve Function in Patients With Syndrome X Detected By [ 123 I]Metaiodobenzylguanidine Myocardial Scintigraphy

Cited by 141 publications

References 33 publications

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Impact of age and sex on left ventricular function determined by coronary computed tomographic angiography: results from the prospective multicentre CONFIRM study

Combination of Variant and Microvascular Angina

Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X)

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Product

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Abnormal Cardiac Adrenergic Nerve Function in Patients With Syndrome X Detected By [ ¹²³ I]Metaiodobenzylguanidine Myocardial Scintigraphy