Pathophysiology, Diagnosis, and Current Management Strategies for Chest Pain in Patients With Normal Findings on Angiography

Suwaidi, Jassim Al; Higano, Stuart T.; Holmes, David R.; Lerman, Amir

doi:10.1016/s0025-6196(11)63226-6

Cited by 23 publications

(13 citation statements)

References 99 publications

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“…The pathophysiology of the CSX has not been fully elucidated. It is likely that multiple factors such as impaired coronary flow reserve, inflammation, insulin resistance, enhanced sodium-hydrogen exchange activity, abnormal pain perception, and increased microvascular tonus interact to produce this syndrome [3]. Endothelial dysfunction and subsequent microvascular ischemia are, however, the main proposed factors underlying CSX [4].…”

Section: Resultsmentioning

confidence: 99%

Plasma asymmetric dimethylarginine and L-arginine levels in patients with cardiac syndrome X

Okyay¹,

Çengel²,

Şahinarslan³

et al. 2007

Coronary Artery Disease

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Section: Resultsmentioning

confidence: 99%

Plasma asymmetric dimethylarginine and L-arginine levels in patients with cardiac syndrome X

Okyay¹,

Çengel²,

Şahinarslan³

et al. 2007

Coronary Artery Disease

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“…The pathophysiology of CSX has not been clearly identifi ed yet, although multiple abnormalities including abnormal coronary fl ow reserve, insulin resistance, abnormal autonomic control, enhanced sodium-hydrogen exchange activity, abnormal cardiac sensitivity, microvascular spasm, endothelial dysfunction, oxidative stress and silent atherosclerosis have been reported (4)(5)(6)(7) . Previous studies have demonstrated that the elevated levels of infl ammatory molecules are markers of an atherosclerotic disease activity and also indicate an increased risk of the progression of atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 3-10% of patients undergoing coronary arteriography because of typical chest pain have normal coronary arteries and qualify for the defi nition of CSX (1)(2)(3) . A wide range of pathophysiological mechanisms involving infl ammation, changes in micro-vascular tonus, impaired coronary fl ow reserve, insulin resistance, altered sodium-hydrogen exchange activity and increased sensitivity of cardiac pain have been described in several studies (4)(5)(6) . Among these mechanisms, endothelial dysfunction and micro-vascular ischemia mediated by infl ammation have been proposed to be the main factor underlying CSX; however, the exact mechanism remains unknown (7) .…”

Section: Introductionmentioning

confidence: 99%

Association of Monocyte-to-HDL Cholesterol Ratio with Cardiac Syndrome X is Linked to Systemic Inflammation

Alizade¹,

Avcı²,

Güner³

et al. 2016

Kosuyolu Heart Journal

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Introduction: The aim of this study was to investigate an easily available infl ammatory marker and monocyteto-high-density lipoprotein cholesterol ratio (MHR) in patients with cardiac syndrome X (CSX). Patients and Methods:The study population included 100 patients of which 50 had CSX (CSX group) and 50 had normal coronary angiograms (control group). Results:Total white blood cell (WBC) count, monocyte count, neutrophil count, NLR, high-sensitivity C-reactive protein (hs-CRP), C-reactive protein (CRP) and MHR were higher in the CSX group (p< 0.05), whereas high-density lipoprotein cholesterol (HDL-C) level was signifi cantly lower in the CSX group as compared with that in the control group (p< 0.05). In the correlation analysis, MHR revealed a signifi cantly positive correlation with hs-CRP (r= 0.375, p< 0.001) and CRP (r= 0.403, p< 0.001). In the multivariate logistic regression analysis, MHR was independently associated with the presence of CSX (odds ratio: 1.250, 95% confi dence interval [CI]: 1.240-1.461, p< 0.001). Using a cut-off level of 90.6, pre-procedural MHR predicted the presence of slow coronary fl ow (SCF) with a sensitivity of 78% and specifi city of 70%. Conclusion:In conclusion, our fi ndings revealed that higher MHR levels were signifi cantly and independently associated with the presence of CSX.

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“…7 All these abnormalities may have been associated with endothelial dysfunction. The most influential explanation includes generalized endothelial dysfunction, inflammation and increased pain sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Association between microvascular angina and erectile dsyfunction

et al. 2013

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Although the origin of cardiac syndrome X (CSX) is still debated, endothelial dysfunction leading to reduced coronary microvascular dilatory response and increased coronary resistance is thought to have an important role in the pathogenesis. Erectile dysfunction (ED) is associated with risk factors resulting in endotelial dysfunction. Although the relationship between cardiovascular disease and ED has been well established; the relation between CSX and ED has not been extensively studied so far. We herein aimed to study ED in patients with CSX. The study was designed as a prospective case-control study. Blood samples were analyzed with respect to concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. The subjects answered the native language five-item version of the International Index of Erectile Function Questionnaire (IIEF)-5. Each question was scored from 0 to 5 with a maximum score of 25 denoting healty subjects. We investigated the IIEF-5 score in 51 men with CSX (mean age=48.2±6.4 years), 53 men with demonstrated coronary artery disease (CAD) (mean age=48.3±4.8 years) and 52 male controls with normal coronary arteries (mean age=47.2±6.0 years). Mean IIEF-5 scores were 19.88±3.07 for CSX group, 18.83±3.31 for CAD group and 21.40±2.94 for control group. IIEF-5 scores in CSX group were found to be significantly lower than the those of control group (P<0.001). There were no significant differences in IIEF-5 scores between CSX and CAD groups (P=0.09). We have shown for the first time that patients with CSX have lower IIEF-5 scores compared with controls with normal coronary angiograms. This study suggests that ED and CSX may be different manifestations of a common underlying vascular pathology and vasculogenic ED is frequently seen in CSX at least as much as in CAD.

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Pathophysiology, Diagnosis, and Current Management Strategies for Chest Pain in Patients With Normal Findings on Angiography

Cited by 23 publications

References 99 publications

Plasma asymmetric dimethylarginine and L-arginine levels in patients with cardiac syndrome X

Plasma asymmetric dimethylarginine and L-arginine levels in patients with cardiac syndrome X

Association of Monocyte-to-HDL Cholesterol Ratio with Cardiac Syndrome X is Linked to Systemic Inflammation

Association between microvascular angina and erectile dsyfunction

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