Coronary artery diseaseNoninvasive Evaluation of Flow Reserve in the Left Anterior Descending Coronary Artery in Patients With Cardiac Syndrome X
Section snippets
Methods
We enrolled 17 patients with typical cardiac syndrome X in the study (8 men; mean 55 ± 10 years of age). Cardiac syndrome X was diagnosed according to the presence of typical effort angina, ST-segment depression ≥1 mm on exercise stress testing, and angiographically normal coronary arteries. As a control group, we studied 17 healthy control subjects who were comparable to patients with regard to age and gender (7 men; mean 55 ± 10 years of age).
Patients and controls were excluded in cases of
Results
The main clinical characteristics of patients with cardiac syndrome X and healthy control subjects are presented in Table 1. The 2 groups were similar with respect to age, gender, and cardiovascular risk factors. The mid-distal LAD was correctly visualized by transthoracic echocardiographic color Doppler and myocardial contrast echocardiographic evaluation was effectively performed in all subjects without clinical side effect. Adenosine was also infused in all patients without significant side
Discussion
This is the first study showing an impairment of coronary microvascular function in patients with cardiac syndrome X by combined assessment of CFR by transthoracic Doppler echocardiography of the LAD and by MCE. The results obtained with the 2 methods were highly correlated, thus lending further support to the importance of abnormalities in coronary microvascular function as a cause of the syndrome. Further, in this study, we were able to identify a subgroup of patients with syndrome X in whom
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2023, Trends in Cardiovascular MedicineCitation Excerpt :Data regarding coronary microvascular dysfunction are limited [87]. For patients with cardiac syndrome X, MCE-derived MBF reserve and β reserve were highly correlated with the transthoracic echocardiography coronary flow velocity reserve of the LAD, and there was a significant linear correlation among the coronary flow velocity reserve, β reserve (r=0.92, p<0.0001), and MBF (A × β) reserve (r=0.77; p<0.0001) [87]. A recent study indicated that an MBF (A × β) reserve <2 classified 37% of patients with chest pain and no obstructive CAD as having coronary microvascular dysfunction [55], which is within the prevalence reported with transthoracic echocardiography coronary flow velocity reserve [99] and invasively [43] in similar populations; however, there was no validation with other coronary microvascular dysfunction assessment methods [55].
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