Relation between cardiovascular risk factors and coronary microvascular dysfunction in cardiac syndrome X

Sestito, Alfonso; Lanza, Gaetano Antonio; Monaco, Antonio Di; Lamendola, Priscilla; Careri, Giulia; Tarzia, Pierpaolo; Pinnacchio, Gaetano; Battipaglia, Irma; Crea, Filippo

doi:10.2459/jcm.0b013e3283406479

Cited by 42 publications

(29 citation statements)

References 32 publications

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“…10 Using this intracoronary thermodilution method, the present study was undertaken to document CMR directly in patients with CSX, and for the first time, we demonstrated direct evidence of CMD in patients with CSX, as represented by the increased IMR and the impaired CFR. Our results about CFR are in agreement with previous reports as mentioned above, [1][2][3] by noninvasive techniques, indicating impaired CFR in patients with CSX. Our findings that severity of myocardial ischemia in these patients is related to thermodilution-derived CFR endorse the results of previous clinical studies 7,19 that DTS can reflect transthoracic CFR in patients with microvascular angina.…”

Section: Discussionsupporting

confidence: 83%

“…[1][2][3][4][5][6] The likely pathophysiological mechanism for CSX is suggested to be coronary microvascular dysfunction (CMD), presenting with increased coronary microvascular resistance (CMR) and impaired coronary flow reserve (CFR), thus resulting in myocardial ischemia and subsequent angina pectoris. [1][2][3][4] However, although abnormal CFR or myocardial perfusion defects were demonstrated by transthoracic Doppler echocardiography, 1,2,7 cardiovascular MR, 1,8 and positron emission tomography, 3 the elevated CMR has never been directly documented, and the correlation between CMR and severity of ischemia has not been elucidated in this setting.…”

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confidence: 99%

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Thermodilution-Derived Coronary Microvascular Resistance and Flow Reserve in Patients With Cardiac Syndrome X

Luo

Long

et al. 2014

Circ: Cardiovascular Interventions

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Background— Although increased coronary microvascular resistance (CMR), resulting in coronary microvascular dysfunction, is speculated to be responsible for myocardial ischemia in patients with cardiac syndrome X (CSX), it has never been directly demonstrated, and the correlation between CMR and severity of myocardial ischemia has not been elucidated in this setting. This study aimed to ascertain the increased CMR directly and to explore the relationship between CMR and severity of ischemia in patients with CSX. Methods and Results— We studied 18 patients with CSX and 18 age- and sex-matched control subjects. Thermodilution-derived coronary flow reserve and index of microvascular resistance were measured using a pressure–temperature sensor-tipped coronary wire. Exercise treadmill test was performed by the Bruce protocol for calculating Duke treadmill score. Coronary flow reserve was significantly lower (2.37±0.81 versus 3.68±0.72; P <0.001) and index of microvascular resistance was higher (33.1±7.9 versus 18.8±5.6 U; P <0.001) in patients with CSX compared with those in control subjects. The Duke treadmill score was correlated positively to coronary flow reserve ( r =0.539; P =0.021) and negatively to index of microvascular resistance ( r =−0.742; P <0.001) in patients with CSX. Conclusions— Using an intracoronary thermodilution method, we for the first time directly demonstrated an increased microvascular resistance in patients with CSX. Furthermore, severity of ischemia was found to be intimately associated with CMR in this setting.

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Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

Thermodilution-Derived Coronary Microvascular Resistance and Flow Reserve in Patients With Cardiac Syndrome X

Luo

Long

et al. 2014

Circ: Cardiovascular Interventions

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“…Other studies failed to show hypertension as an independent predictor of ED in these patients [7]. Thus this relation deserves further investigation in larger studies.…”

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confidence: 87%

“…Indeed, CRP levels were previously found increased in CSX patients, and were also shown to correlate with systemic ED and with endotheliumdependent CMVD [4][5][6]. Notably, in a recent study we found that CRP levels were the only independent predictor of endothelium-independent CMVD in a group of CSX patients [7].…”

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confidence: 99%

Obesity: a new risk factor for cardiac syndrome X?

Lamendola

Lanza

2012

Cardiovasc Drugs Ther

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“…The suggested normal range for CFVR has varied over the past years [38,39]. CMD was first defined with a cutoff point of 2.5, which then changed to 2.0 [16,40,41].…”

Section: Discussionmentioning

confidence: 99%

Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease: The iPOWER Study

Raft¹,

Frestad

Michelsen³

et al. 2017

J Vasc Res

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Purpose: We investigated whether impaired flow-mediated dilation (FMD) and plasma biomarkers reflecting endothelial dysfunction are associated with coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease (CAD). Methods: Patients (n = 194) were randomly selected women with angina pectoris and no obstructive CAD (<50% stenosis). A reference population of asymptomatic women without CAD (n = 25) was included. We measured FMD in the brachial artery by high-resolution ultrasound. Coronary flow velocity reserve (CFVR) was assessed by transthoracic Doppler flow echocardiography (TTDE) of the left anterior descending artery during rest and high-dose dipyridamole infusion. CMD was defined as CFVR <2. Results: FMD and CFVR were measured in 128 patients and 21 controls. Mean (SD) age was 64.5 (8.9) years, mean CFVR was 2.3 (2.0-2.7), and mean FMD was 8.4% (4.8%) in angina patients. Angina patients had a higher risk factor burden compared with the reference population. Measures of peripheral endothelial dysfunction and endothelial plasma biomarkers did not differ according to angina or CFVR. CFVR and FMD did not correlate (Spearman ρ = -0.07, p = 0.45). Conclusions: FMD and biomarkers of endothelial dysfunction did not identify individuals with CMD assessed as impaired CFVR by TTDE in women with angina and no obstructive CAD.

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Relation between cardiovascular risk factors and coronary microvascular dysfunction in cardiac syndrome X

Abstract: In CSX patients, both endothelium-dependent and endothelium-independent CMVD cannot be reliably predicted by CVRFs (including serum CRP levels), alone or in combination.

Cited by 42 publications

References 32 publications

Thermodilution-Derived Coronary Microvascular Resistance and Flow Reserve in Patients With Cardiac Syndrome X

Thermodilution-Derived Coronary Microvascular Resistance and Flow Reserve in Patients With Cardiac Syndrome X

Obesity: a new risk factor for cardiac syndrome X?

Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease: The iPOWER Study

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