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Horii T, Oikawa Y, Shimada A, Mihara K. Real-world risk of cardiovascular diseases in patients with type 2 diabetes associated with sodium-glucose cotransporter 2 inhibitors in comparison with metformin: A propensity score-matched model analysis in Japan. J Diabetes Investig 2023; 14:1262-1267. [PMID: 37517084 PMCID: PMC10583649 DOI: 10.1111/jdi.14062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
We aimed to compare the effects of cardiovascular disease risk in Japanese patients with type 2 diabetes on sodium-glucose cotransporter 2 inhibitors (SGLT2Is) or metformin. This retrospective, real-world cohort study was carried out using a claims database and propensity score matching; 58,402 eligible patients (29,201 per group) were included. The outcomes included nonfatal myocardial infarction, angina pectoris, nonfatal stroke, hospitalization for heart failure and composite end-points. The hazard ratio (HR) for the composite end-point was 0.79, which was lower for SGLT2Is than for metformin. For male patients (HR 0.76), patients aged <65 years (HR 0.94), patients aged ≥75 years (HR 0.78) and patients with body mass index ≥25 kg/m2 (HR 0.76), the HRs for the composite end-point were significantly lower in the SGLT2I group than in the metformin group. SGLT2Is might be superior to metformin in reducing the composite risk of cardiovascular disease in patients with type 2 diabetes.
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Affiliation(s)
- Takeshi Horii
- Department of Pharmacy, Faculty of PharmacyMusashino UniversityTokyoJapan
- Department of Endocrinology and Diabetes, School of MedicineSaitama Medical UniversitySaitamaJapan
| | - Yoichi Oikawa
- Department of Endocrinology and Diabetes, School of MedicineSaitama Medical UniversitySaitamaJapan
| | - Akira Shimada
- Department of Endocrinology and Diabetes, School of MedicineSaitama Medical UniversitySaitamaJapan
| | - Kiyoshi Mihara
- Department of Pharmacy, Faculty of PharmacyMusashino UniversityTokyoJapan
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Kalçık M, Yesin M, Güner A, Bayam E, Yetim M, Doğan T, Bekar L, Çelik O, Karavelioğlu Y. Echocardiographic measurement of epicardial adipose tissue thickness in patients with microvascular angina. Interv Med Appl Sci 2020; 11:106-111. [PMID: 32148914 PMCID: PMC7044543 DOI: 10.1556/1646.11.2019.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Impaired coronary microcirculation, inflammation, and endothelial dysfunction were reported etiological factors for microvascular angina (MVA). Recently, increased epicardial adipose tissue (EAT) thickness has been associated with hypertension, metabolic syndrome, and coronary artery disease in general population. In this study, we aimed to evaluate the EAT thickness in patients with MVA. Methods This study enrolled 200 patients (83 males; mean age: 55.4 ± 8.2 years) who have been diagnosed with MVA and 200 controls (89 males; mean age: 54.4 ± 8.5 years). All patients underwent transthoracic echocardiography, and EAT thickness was measured from a parasternal long-axis view as the hypoechoic space on the right ventricular free wall. Results The mean EAT thickness was significantly higher in MVA patients than the controls (5.5 ± 1.1 vs. 4.9 ± 0.7 mm; p < 0.001). Multiple logistic regression analysis showed that increased EAT thickness was an independent predictor of MVA (OR = 1.183, 95% CI = 1.063-1.489; p = 0.023). In receiver operating characteristic curve analyses, EAT thickness above 5.3 mm predicted MVA with a sentivity of 68% and a specificity of 63% (AUC = 0.711, 95% CI = 0.659-0.762; p < 0.001). Conclusions The EAT thickness was observed significantly higher in MVA patients as compared to controls. Increased EAT thickness may be associated with mechanisms that play a major role in the pathogenesis of MVA.
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Affiliation(s)
- Macit Kalçık
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey
| | - Ahmet Güner
- Department of Cardiology, Kosuyolu Kartal Training and Research Hopital, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Mucahit Yetim
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Tolga Doğan
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Lütfü Bekar
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Mugla Sitki Koçman University Training and Research Hospital, Mugla, Turkey
| | - Yusuf Karavelioğlu
- Faculty of Medicine, Department of Cardiology, Hitit University, Çorum, Turkey
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Liang KW, Lee WJ, Lee IT, Lee WL, Wang JS, Wu JP, Sheu WHH. Subjects with microvascular angina have longer GT repeats polymorphism in the haem oxygenase-1 gene promoter. Biomarkers 2020; 25:144-148. [PMID: 31916865 DOI: 10.1080/1354750x.2020.1713214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Few studies have investigated haem oxygenase-1 gene (HMOX1) promoter polymorphism in microvascular angina (MVA).Materials and methods: HMOX1 promoter (GT)n repeats were examined in healthy controls (N = 220) and MVA subjects (N = 181).Results: The distribution of genotype of SS, SL and LL were significantly different in MVA (17%, 51%, 33%) vs. normal controls (35%, 46%, 20%) (p < 0.001, S allele: ≤30 repeats, L allele: >30 repeats). In multivariate analysis, carrier of L allele (odds ratio 2.772, p < 0.001) was a significant predictor for the diagnosis of MVA.Conclusions: Subjects with MVA had longer HMOX1 promoter (GT)n repeats than the healthy controls. Trial registration number: NCT01198730 at https://clinicaltrials.gov.
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Affiliation(s)
- Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Life Science, Tung-Hai University, Taichung, Taiwan
| | - I-Te Lee
- Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Jun-Sing Wang
- Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jen-Pey Wu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wayne H-H Sheu
- Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Effects of a Cardiac Rehabilitation Program Versus Usual Care on Cardiopulmonary Function in Patients With Cardiac Syndrome X. J Cardiopulm Rehabil Prev 2019; 40:41-47. [PMID: 31869312 DOI: 10.1097/hcr.0000000000000439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Because of uncertainty in the pathophysiological process, the treatment of cardiac syndrome X (CSX) is still under study. Addressing the effects of cardiac rehabilitation (CR) can help promote the prescription of this modality as an adjuvant therapy for these patients. METHODS This study was performed on 30 patients with effort-induced angina pectoris using a positive exercise test and/or myocardial perfusion scan in the absence of obvious stenosis or a stenosis of <50% on coronary angiography. The patients were divided into the CR and usual care (UC) groups and underwent cardiopulmonary exercise testing with gas exchange analysis before and after the study. The Duke Treadmill Score was used to compare prognosis and survival estimates of patients. RESULTS An increase in peak oxygen uptake ((Equation is included in full-text article.)O2) was significantly higher in the CR group than in the control group (P = .017). Resting (Equation is included in full-text article.)O2 was also increased in the CR group, but its difference with the UC group was not statistically significant. Resting O2 pulse was increased in the CR group, which significantly differed between groups (P = .041). Exercise test duration and the Duke Treadmill Score significantly increased in the CR group as compared with the UC group (P = .003 and P = .002, respectively). Also, recovery heart rate in the first minute was significantly improved in CR group. CONCLUSION Adding a 4-wk course of CR to UC for patients with CSX not only increased the Duke Treadmill Score and exercise test duration but also improved the resting O2 pulse, peak (Equation is included in full-text article.)O2, and first-minute recovery heart rate.
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Assessment of the relationship between coronary flow rates and myocardial perfusion abnormality in patients with nonobstructive coronary artery disease: an observational study in cardiac syndrome X and coronary slow flow. Nucl Med Commun 2019; 40:1122-1129. [PMID: 31568270 DOI: 10.1097/mnm.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this study, we evaluated and compared the level of myocardial ischaemia caused by cardiac syndrome X (CSX) and coronary slow flow (CSF) with single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), and determined if changes in the level of myocardial ischaemia exist in CSF and CSX cases according to thrombolysis in myocardial infarction frame count (TFC). MATERIALS AND METHODS The study population consisted of 66 patients with CSF and 78 angiographically normal patients (36 of them with CSX and 42 of them healthy controls). The coronary flow rates of all patients were documented using TFC. Subsequently, all patients were evaluated with SPECT-MPI and categorized into the following groups according to their results: patients with CSF, patients with CSX, and patients with normal coronary arteries. Finally, we investigated whether a relationship existed between the SPECT-MPI and TFC results from these three groups. RESULTS All ischaemia scores for MPI were significantly higher in the CSF group than in the CSX and control groups (P < 0.05). TFC was significantly associated with the severity of ischaemia in the CSF patients. There was a significant positive correlation between the summon difference score (SDS) and mean TFC value (P < 0.05) as well as between the SDS and each individual coronary TFC value in the CSF patients (P < 0.05). The number of vessels involved in CSF was positively correlated with the SDS. CONCLUSION CSF is associated with more severe myocardial ischaemia than CSX. The level of myocardial ischaemia on SPECT-MPI was correlated with the TFC and the number of affected coronary vessels in patients with CSF. These results suggest that CSF is a more serious clinical entity than CSX, and that the clinical severity of CSF appears to increase as the coronary flow rate decreases.
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Önal B, Özen D, Demir B, Akkan AG, Özyazgan S. Receptor for advanced glycation end products gene polymorphisms in cardiac syndrome X. Biomed Rep 2019; 11:123-129. [PMID: 31423307 DOI: 10.3892/br.2019.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/05/2019] [Indexed: 11/06/2022] Open
Abstract
Endothelial and microvascular dysfunction serve important roles in the formation and pathogenesis of cardiac syndrome X (CSX). Expression of receptor for advanced glycation end products (RAGE) is suggested to be increased in several conditions, including diabetes, inflammation and vascular diseases. In the present study, RAGE gene polymorphisms in patients with CSX and healthy controls were investigated. A total of 114 patients, diagnosed with CSX using coronary angiography results following complaints of angina and objective ischemia, and 103 healthy controls participated in the study. Whether there was a difference in genotype distributions of RAGE gene -374T/A, -429T/C and Glys82Ser polymorphisms between patients with CSX and healthy controls was investigated. Following DNA isolation from blood samples of the participants, the polymorphic regions were examined by quantitative polymerase chain reaction, and the genotyping results were statistically analyzed. When the genotypic distributions of -374T/A, -429T/C and Gly82Ser polymorphisms were investigated in patients with CSX and healthy controls, no statistically significant differences were identified between the two groups (P>0.05). Likewise, no statistically significant differences were observed in the allelic distributions of all 3 polymorphic regions (P>0.05). To the best of our knowledge, the present study also investigated the association between CSX and RAGE gene polymorphisms for the first time. No statistically significant differences in RAGE gene polymorphisms between the CSX and control groups were observed. We hypothesized that significant results may be obtained by increasing the numbers of patients and healthy controls in future studies.
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Affiliation(s)
- Burak Önal
- Department of Medical Pharmacology, Faculty of Medicine, Biruni University, Istanbul 34010, Turkey
| | - Deniz Özen
- Department of Medical Pharmacology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul 34096, Turkey
| | - Bülent Demir
- Department of Cardiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul 34147, Turkey
| | - Ahmet G Akkan
- Department of Medical Pharmacology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul 34096, Turkey
| | - Sibel Özyazgan
- Department of Medical Pharmacology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul 34096, Turkey
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Saadat M, Masoudkabir F, Afarideh M, Ghodsi S, Vasheghani-Farahani A. Discrimination between Obstructive Coronary Artery Disease and Cardiac Syndrome X in Women with Typical Angina and Positive Exercise Test; Utility of Cardiovascular Risk Calculators. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E12. [PMID: 30646563 PMCID: PMC6359077 DOI: 10.3390/medicina55010012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/17/2022]
Abstract
Introduction: Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). Objective: We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). Methods: 559 women participated in the study. Three risk scores, including (1) newly pooled cohort equation of American College of Cardiology/American Heart Association (ACC/AHA) to predict 10 years risk of first atherosclerotic cardiovascular hard event (ASCVD), (2) Framingham risk score (FRS) for the prediction of 10 years coronary heart disease, and (3) the SCORE tool to estimate 10-year risk of cardiovascular mortality (SCORE), were applied. Results: CAD was diagnosed in 51.5% of the patients. 11.6% of the population had ASCVD < 2.5%, and only 13.8% of these patients had CAD on their CAG. By choosing FRS, 14.4% of patients had FRS < 7.5%, and only 11.3% of these patients had recorded CAD on CAG, while the rest of the patients were diagnosed as CSX. Using the SCORE model, 13.8% of patients had the least value (<0.5%) in whom the prevalence of CAD was 19.9%. The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE (p value for all AUROCs < 0.001). The Hosmer⁻Lemeshow chi squares (df, p value) for calibration were 8.787 (8, 0.361), 11.125 (8, 0.195), and 10.618 (8, 0.224) for ASCVD, FRS, and SCORE, respectively. Conclusions: Patients who have ASCVD < 2.5% or FRS < 7.5% may be appropriate cases for noninvasive imaging (Such as coronary CT angiography). CAG is indicated for patients with ASCVD ≥ 7.5% and FRS ≥ 15%, whereas the patients with intermediate risk need comprehensive patient⁻physician shared decision-making.
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Affiliation(s)
- Mohammad Saadat
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Mohsen Afarideh
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Saeed Ghodsi
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
- Department of Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
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Masoudkabir F, Vasheghani-Farahani A, Hakki E, Poorhosseini H, Sadeghian S, Abbasi SH, Bahmanyar S, Kassaian SE. Novel Scoring System for Prediction of Cardiac Syndrome X in Women with Typical Angina and a Positive Exercise Tolerance Test. Tex Heart Inst J 2018; 45:5-10. [PMID: 29556144 DOI: 10.14503/thij-16-5906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population. Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it. The derivation dataset (809 patients) was calibrated by uing a Hosmer-Lemeshow goodness-of-fit test (8 degrees of freedom; χ2=12.9; P=0.115), and the area under the curve was 0.758. The validation dataset (167 patients) was calibrated in the same way (8 degrees of freedom; χ2=9.0; P=0.339), and the area under the curve was 0.782. Independent predictors of CSX were age <55 years; negative histories of smoking, diabetes mellitus, hyperlipidemia, hypertension, or familial premature coronary artery disease; and highly positive ETTs. A total score >9.5 was the optimal cutoff point for differentiating CSX from obstructive coronary artery disease. Our proposed scoring system is a simple, objective, and accurate system for distinguishing CSX from obstructive coronary artery disease in women with typical angina and positive ETTs. It may help determine which of these patients need invasive coronary angiograms or noninvasive tests like computed tomographic coronary angiography.
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Lu TM, Lee TS, Lin SJ, Chan WL, Hsu CP. The prognostic value of asymmetric dimethylarginine in patients with cardiac syndrome X. PLoS One 2017; 12:e0188995. [PMID: 29206850 PMCID: PMC5716529 DOI: 10.1371/journal.pone.0188995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022] Open
Abstract
Background The pathophysiology of cardiac syndrome X is multifactorial and endothelial dysfunction has been implicated as important contributing factor. Asymmetric dimethylarginine (ADMA), characterized as a circulating endogenous inhibitor of nitric oxide synthase, may have been implicated as an important contributing factor for the development of endothelial dysfunction. In this study, we aim to assess the predictive power of ADMA for long-term prognosis in patients with cardiac syndrome X. Methods and results We enrolled 239 consecutive patients with cardiac syndrome X diagnosed by coronary angiography. The mean age was 58.7±10.1 years. The patients were grouped into tertiles according to the plasma ADMA levels: <0.38 μmol/l (tertile I), 0.38–0.44 μmol/l (tertile II), and >0.44 μmol/l (tertile III). All patients were followed up for a mean period of 6.5±1.5 years (median: 6.3 years, inter-quartile range: 5.7–8.0 years). During the follow-up period, major adverse events (MAE) were observed in 15 patients (6.3%), including 13 deaths. The plasma ADMA levels in patients who developed MAE were significantly higher than those who did not (0.48±0.06 μmol/l vs. 0.42±0.08 μmol/l, p = 0.005). In multivariate Cox regression analysis adjusted for age, eGFR and LVEF, ADMA tertile I and II were identify to be associated with a significantly lower risk of MAE compared to ADMA tertile III (p = 0.017). By considering the plasma ADMA level as a continuous variable, the plasma ADMA level remained a significant independent predictor for outcomes of MAE, and the relative risk of MACE increased by 50% when plasma ADMA level increased by 1 SD of value (p = 0.018). Conclusions In patients with cardiac syndrome X, elevated plasma ADMA levels appeared to be an independent predictor of long-term adverse clinical outcomes.
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Affiliation(s)
- Tse-Min Lu
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- Department of Health Care Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| | - Tzong-Shyuan Lee
- Department of Physiology, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| | - Shing-Jong Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | - Wan-Leong Chan
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- Department of Health Care Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | - Chiao-Po Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
- * E-mail:
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Dogan A, Oylumlu M. Increased monocyte-to-HDL cholesterol ratio is related to cardiac syndrome X. Acta Cardiol 2017; 72:516-521. [PMID: 28853337 DOI: 10.1080/00015385.2017.1299521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Cardiac syndrome X (CSX) is typically identified with ischaemia in treadmill exercise test or stress myocardial perfusion scintigraphy as well as angina-like chest pain without stenosis in coronary angiography. The purpose of the present study is to investigate the association between cardiac syndrome X and monocyte-to-HDL cholesterol ratio (MHR) which is a new marker associated with inflammation. PATIENTS AND METHODS A total of 230 patients (105 patients with cardiac syndrome X and 125 normal controls) were included in the study. Peripheral venous blood samples were drawn from all study population before coronary angiography for measuring MHR and other haematological parameters. RESULTS The patients with cardiac syndrome X were more likely to have higher platelet counts, plateletcrit (PCT), monocyte count and MHR values. Monocyte count and MHR of the CSX group were significantly higher than the control group [0.53 (0.35-1) vs. 0.49 (0.23-0.96); p = .002, .011 (0.006-0.038) vs. 0.010 (0.004-0.034); p < .001, respectively]. HDL-cholesterol levels of the CSX group were significantly lower than the control groups (46.3 ± 10.1 vs. 49.6 ± 11.6; p = .021). Higher MHR and PCT values were found to be associated with the presence of CSX by multivariate logistic regression analysis. CONCLUSIONS Elevated MHR level independently was found in association with the presence of CSX. The value of MHR appears additive to conventional expensive methods commonly used in CSX prediction.
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Affiliation(s)
- Adnan Dogan
- Department of Cardiology, Dumlupinar University School of Medicine, Kutahya, Turkey
| | - Muhammed Oylumlu
- Department of Cardiology, Dumlupinar University School of Medicine, Kutahya, Turkey
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Liang KW, Sheu WHH, Lee WJ, Lee WL, Fu CP, Wang JS. Differential expression of circulating vascular cell adhesion molecule-1 in subjects with coronary artery disease and cardiac syndrome X without known diabetes mellitus. Biomarkers 2017; 22:798-804. [PMID: 28675064 DOI: 10.1080/1354750x.2017.1351003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Inflammation is one of the mechanisms underlying cardiac syndrome X (CSX). OBJECTIVES Few studies have compared the expression of inflammatory or adhesion molecules between coronary artery disease (CAD) versus CSX. MATERIALS AND METHODS Ninety-two CSX and 145 CAD subjects without known diabetes mellitus underwent coronary angiogram for angina. RESULTS Vascular cell adhesion molecule (VCAM)-1 (median, 507 versus 431 ng/ml, p = 0.001) was significantly higher in the CAD group. In the binary regression, VCAM-1 was a significant differential factor for CAD versus CSX. DISCUSSION AND CONCLUSION Adhesion molecules might be implicated in the differential expression of macro versus microvascular coronary disease. TRIAL REGISTRATION NUMBER NCT01198730 at https://clinicaltrials.gov.
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Affiliation(s)
- Kae-Woei Liang
- a Cardiovascular Center , Taichung Veterans General Hospital , Taichung , Taiwan.,b School of Medicine , National Yang Ming University , Taipei , Taiwan.,c Department of Medicine , China Medical University , Taichung , Taiwan
| | - Wayne H-H Sheu
- b School of Medicine , National Yang Ming University , Taipei , Taiwan.,d Division of Endocrinology and Metabolism, Department of Medicine , Taichung Veterans General Hospital , Taichung , Taiwan.,e Institute of Biomedical Sciences , National Chung Hsing University , Taichung , Taiwan.,f School of Medicine , National Defense Medical Center , Taipei , Taiwan
| | - Wen-Jane Lee
- g Department of Medical Research , Taichung Veterans General Hospital , Taichung , Taiwan.,h Tung-Hai University , Taichung , Taiwan
| | - Wen-Lieng Lee
- a Cardiovascular Center , Taichung Veterans General Hospital , Taichung , Taiwan.,b School of Medicine , National Yang Ming University , Taipei , Taiwan
| | - Chia-Po Fu
- d Division of Endocrinology and Metabolism, Department of Medicine , Taichung Veterans General Hospital , Taichung , Taiwan
| | - Jun-Sing Wang
- b School of Medicine , National Yang Ming University , Taipei , Taiwan.,d Division of Endocrinology and Metabolism, Department of Medicine , Taichung Veterans General Hospital , Taichung , Taiwan
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Kandaz C, Önal B, Özen D, Demir B, Akkan AG, Özyazgan S. Investigation of MTHFR gene C677T polymorphism in cardiac syndrome X patients. J Clin Lab Anal 2017; 32. [PMID: 28481466 DOI: 10.1002/jcla.22247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Definition of Cardiac Syndrome X (CSX) refers to groups of patients with positive exercise stress test and normal epicardial coronary arteries on coronary angiography accompanied by chest pain. Although the etiology of CSX is not completely understood, there is a common consensus that its pathophysiology may be associated with endothelial dysfunction resulting in impaired coronary flow. Some polymorphisms observed on the MTHFR gene cause inactivation of the MTHFR enzyme, leading to hyperhomocysteinemia and homocysteinuria, which are prominent risk factors of cardiovascular and cerebrovascular diseases. It was aimed to explain the association of the endothelial dysfunction, which is thought to play a role in the pathophysiology of CSX, with C677T polymorphism on MTHFR gene based on genetic basis. METHODS A total of 176 CSX patients and 196 healthy subjects with similar age and clinical features were compared in terms of C677T polymorphism of the MTHFR gene. RESULTS AND CONCLUSION There was no significant difference in terms of MTHFR gene C677T polymorphism between CSX patients and controls. When genotypic distribution was compared based on gender in both patients and controls, no significant difference was found between male and female subjects (P>.05). As fasting blood sugar and urea values were significantly higher, alanine aminotransferase and gamma-glutamyl transferase levels were significantly lower in the patients than the controls (P<.05). Described family story of the patients was significantly higher than the controls (P<.05). These suggest that homocysteine metabolism in CSX is not directly related to the endothelial dysfunction and thus the effect on the microvascular circulation.
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Affiliation(s)
- Cemre Kandaz
- Department of Medical Pharmacology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Burak Önal
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Deniz Özen
- Department of Medical Pharmacology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bülent Demir
- Department of Cardiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - A Gökhan Akkan
- Department of Medical Pharmacology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Özyazgan
- Department of Medical Pharmacology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Liang KW, Sheu WHH, Lee WJ, Lee WL, Pan HC, Lee IT, Wang JS. Post-challenge insulin concentration is useful for differentiating between coronary artery disease and cardiac syndrome X in subjects without known diabetes mellitus. Diabetol Metab Syndr 2017; 9:10. [PMID: 28194232 PMCID: PMC5299675 DOI: 10.1186/s13098-017-0209-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/29/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study demonstrated that subjects with CSX had a higher fasting insulin-resistance (IR) than the controls. However, few studies have investigated the degree of IR, including oral glucose tolerance test (OGTT)-derived indices and profiles of metabolic abnormalities between CSX and coronary artery disease (CAD). METHODS Ninety-two CSX and 145 CAD subjects without known diabetes mellitus (DM) underwent coronary angiogram (CAG) for angina pectoris and also agreed to receive OGTT and glycated hemoglobin (HbA1C) evaluations for screening abnormal glucose regulation and IR. RESULTS CAD group had more subjects with metabolically unhealthy obesity (52.4 vs. 31.5%, p < 0.001) than the CSX group. The CAD group had higher OGTT 2 h glucose and insulin (both p < 0.005) while fasting glucose, insulin and HOMA-IR were similar to those of CSX subjects. In the binary regression analysis, OGTT 2 h insulin and being metabolic unhealthy were significantly different between the CAD and CSX groups, but there were no significant differences in Matsuda index, fasting glucose, insulin, HOMA-IR, or HbA1C. CONCLUSIONS Post challenge OGTT 2 h insulin and being metabolic unhealthy were useful parameters in differentiating between CAD and CSX in subjects without known DM but suffered from angina pectoris and underwent CAG. Different degrees of IR and metabolic abnormalities might be implicated in the pathogenesis of micro vs. macro vascular coronary diseases. Trial registration NCT01198730 at https://clinicaltrials.gov, Registered Sep. 8, 2010.
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Affiliation(s)
- Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wayne H.-H. Sheu
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Tung-Hai University, Taichung, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hung-Chih Pan
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - I.-Te Lee
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Jun-Sing Wang
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
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Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
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Lee IT, Liang KW, Wang JS, Lee WJ, Chen YDI, Lin SY, Lee WL, Sheu WHH. Value of Chromosome 9p21 Polymorphism for Prediction of Cardiovascular Mortality in Han Chinese Without Coronary Lesions: An Observational Study. Medicine (Baltimore) 2015; 94:e1538. [PMID: 26426617 PMCID: PMC4616868 DOI: 10.1097/md.0000000000001538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Variants at chromosome 9p21 are associated with coronary artery disease (CAD). However, the longitudinal effects of 9p21 variants on cardiovascular mortality remain controversial and may depend on whether the patient has CAD. We tested the hypothesis that the single-nucleotide polymorphism (SNP) rs4977574 is associated longitudinally with cardiovascular death in patients without detectable coronary lesions. We enrolled patients who underwent coronary angiography for angina pectoris but had normal angiographic findings. Laboratory analyses and rs4977574 TaqMan genotyping were performed using fasting blood samples collected during hospitalization. Cardiovascular and all-cause mortality rates were acquired from a national database. Among the 679 enrolled subjects with neither myocardial infarction nor an angiographic coronary lesion, 28 (19.0%) of the 147 homozygous GG carriers suffered a cardiovascular death, compared with 63 (11.8%) of the 532 subjects with the AG or AA genotype during the median 12.3 years (interquartile range 8.6-12.7 years) of follow-up. In a recessive model, cardiovascular mortality was significantly higher in subjects with the GG genotype than in those with the other genotypes (hazard ratio, 1.69, 95% confidence interval 1.08 to 2.64; P = 0.021). In this follow-up study, rs4977574, a tag SNP at chromosome 9p21, was shown to be associated with cardiovascular mortality in Taiwanese patients with angina pectoris but no coronary lesions.
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Affiliation(s)
- I-Te Lee
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung (ITL, JSW, SYL, WHHS); School of Medicine, National Yang-Ming University, Taipei (ITL, KWL, SYL, WLL, WHHS); School of Medicine, Chung Shan Medical University (ITL, WHHS); Cardiovascular Center, Taichung Veterans General Hospital (KWL, WLL); Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan (WJL); and Institute for Translational Genomics and Population Sciences, Harbor-UCLA Medical Center, Torrance, California, USA (YDIC)
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Demir B, Önal B, Özyazgan S, Kandaz C, Uzun H, Açıksarı G, Uygun T, Opan S, Karakaya O, Akkan AG. Does Inflammation Have a Role in the Pathogenesis of Cardiac Syndrome X? A Genetic-Based Clinical Study With Assessment of Multiple Cytokine Levels. Angiology 2015; 67:355-63. [DOI: 10.1177/0003319715590057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We compared Turkish patients with cardiac syndrome X (CSX) and controls with respect to serum pro- and anti-inflammatory cytokine levels, as well as the single-nucleotide polymorphisms located in the promoter regions of their related genes. This study included 111 consecutive patients angiographically diagnosed with CSX and 111 healthy controls with similar demographic characteristics. Serum interleukin (IL) 6, tumor necrosis factor α (TNF-α), and IL-10 levels were measured, and the genotypes of the patients and controls were determined using standard methods. Serum IL-6 and IL-10 levels were significantly higher in the CSX group than in the control group ( P < .01, respectively). Serum TNF-α level was lower in the CSX group than in the control group ( P < .001). On the other hand, participants with CSX and healthy controls were not significantly different with respect to the genotype distributions of IL-6, TNF-α, and IL-10 genes. As a result of our study, both pro-inflammatory and anti-inflammatory cytokines may play a role in the pathogenesis of CSX. In contrast, the studied gene polymorphisms did not influence CSX pathogenesis.
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Affiliation(s)
- Bülent Demir
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Burak Önal
- Medical Pharmacology Department, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Sibel Özyazgan
- Medical Pharmacology Department, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Cemre Kandaz
- Medical Pharmacology Department, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Hafize Uzun
- Medical Biochemistry Department, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gönül Açıksarı
- Department of Cardiology, Istinye State Hospital, Istanbul, Turkey
| | - Turgut Uygun
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Selçuk Opan
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Osman Karakaya
- Department of Cardiology, Bakırköy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Gökhan Akkan
- Medical Pharmacology Department, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Liang KW, Lee WJ, Lee WL, Liao YC, Wang KY, Lee IT, Wang JS, Sheu WHH. Circulating adipokines and insulin resistance in subjects with combined cardiac and metabolic syndrome X. Diabetol Metab Syndr 2015; 7:83. [PMID: 26413164 PMCID: PMC4583190 DOI: 10.1186/s13098-015-0078-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 09/17/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study showed that CSX subjects had decreased serum adiponectin but higher leptin and insulin resistance (IR). However, few studies have investigated circulating adipokines and IR in subjects with combined metabolic syndrome X (MetX) and CSX. METHODS Fifty-nine subjects with CSX were retrospectively enrolled from our cardiac catheterization patient databank. Fifty-four subjects with valvular heart disease or arrhythmia and with normal coronary angiograms were recruited as the non-CSX comparison group. The study subjects were reclassified according to the presence or absence of MetX. Circulating adipokines and degree of IR were measured. RESULTS Subjects with combined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin level (median 8.7 vs. 3.3 ng/mL, p < 0.001), but a lower circulating adiponectin level (median 2.8 vs. 12.3 μg/mL, p < 0.001) than those without MetX and CSX. In pairwise comparisons, combined MetX and CSX subjects had a similar circulating adipokines and IR index as those who had only either one syndrome X. In a multivariate regression analysis, serum triglycerides (odds ratio 1.011, p = 0.024) and hypertension (odds ratio 14.453, p = 0.003) were independently associated with diagnosis of combined MetX and CSX. CONCLUSIONS Combined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin but a lower circulating adiponectin level than those without MetX and CSX. Combined syndrome X did not confer more changes on adipokines or IR index comparing with those with only one syndrome X.
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Affiliation(s)
- Kae-Woei Liang
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Jane Lee
- />Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- />Tung-Hai University, Taichung, Taiwan
| | - Wen-Lieng Lee
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ying-Chieh Liao
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Taichung Tzu Chi Hospital, Taichung, Taiwan
- />Department of Medicine, Tzu Chi University School of Medicine, Hualian, Taiwan
| | - Kuo-Yang Wang
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Department of Medicine, China Medical University, Taichung, Taiwan
- />Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - I.-Te Lee
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- />Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
| | - Jun-Sing Wang
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
| | - Wayne H.-H. Sheu
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
- />School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Makarovic Z, Makarovic S, Bilic-Curcic I. Sex-dependent association between coronary vessel dominance and cardiac syndrome X: a case-control study. BMC Cardiovasc Disord 2014; 14:142. [PMID: 25300376 PMCID: PMC4197336 DOI: 10.1186/1471-2261-14-142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated the relevance of left coronary artery dominance in the outcome and prognosis of obstructive coronary artery disease (CAD). However, no studies have investigated the influence of coronary vessel dominance on non obstructive CAD. The aim of this study was to establish the association of left and mixed dominance of the major epicardial arteries with the development of non obstructive CAD and evaluate potential sex-dependent differences in the coronary artery supply. METHODS A total of 484 patients underwent the same diagnostic procedures. The patients were divided into two groups based on their coronary angiogram results: the control group (242 patients with obstructive CAD; coronary artery stenosis of ≥50%) and the experimental group (242 patients with non obstructive CAD; coronary artery stenosis of <50%). RESULTS Significantly more women than men were affected by non obstructive CAD (P = 0.005). Left dominance was more frequent in the non obstructive CAD group than in the control group (P = 0.018) and was more pronounced in women than in men (P = 0.013). Among men with non obstructive CAD, a left supply was more frequent than a mixed supply (P = 0.012). Women with non obstructive CAD had a higher frequency of a left supply, whereas a mixed supply was less frequent in men than in patients with obstructive CAD (P = 0.013 and 0.018, respectively). CONCLUSION These results suggest that left dominance (particularly in women) and the absence of a mixed supply in men could cause regional ischemia, thus affecting the development of non obstructive CAD. Furthermore, sex may determine the incidence of specific coronary artery supply types, therefore influencing disease development and prognosis.
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Affiliation(s)
| | - Sandra Makarovic
- Department of Cardiology, University Hospital Center Osijek and School of Medicine, University of Osijek, J, Huttlera 4, 31000 Osijek, Croatia.
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Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
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Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
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Di Fiore DP, Beltrame JF. Chest pain in patients with 'normal angiography': could it be cardiac? INT J EVID-BASED HEA 2013; 11:56-68. [PMID: 23448331 DOI: 10.1111/1744-1609.12002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Approximately 20% of patients undergoing diagnostic angiography for the evaluation of chest pain are found to have a normal coronary angiogram. Although this finding is generally associated with a low risk of cardiac events, approximately half will continue to experience chest pain over the next 12 months. Therefore, the finding of normal angiography warrants further evaluation of the potential causes for the presenting chest pain if we are to improve the disability suffered by these patients. In this review, the potential non-cardiac and cardiac causes for the chest pain in patients with normal angiography are briefly discussed with an in-depth focus on coronary vasomotor disorders including coronary artery spasm (variant angina) and microvascular disorders such as syndrome X, microvascular angina, the coronary slow flow phenomenon and microvascular spasm.
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Affiliation(s)
- David P Di Fiore
- The Queen Elizabeth Hospital, Discipline of Medicine, The University of Adelaide, Woodville South, South Australia, Australia
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Elbasan Z, Şahin D, Gür M, Şeker T, Kıvrak A, Akyol S, Sümbül Z, Kuloğlu O, Çaylı M. Serum uric acid and slow coronary flow in cardiac syndrome X. Herz 2013; 38:544-8. [DOI: 10.1007/s00059-012-3735-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Revised: 11/11/2012] [Accepted: 11/15/2012] [Indexed: 11/30/2022]
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Liao YC, Liang KW, Lee WJ, Lee WL, Lee IT, Wang JS, Ting CT, Sheu WHH. Leptin to adiponectin ratio as a useful predictor for cardiac syndrome X. Biomarkers 2012; 18:44-50. [DOI: 10.3109/1354750x.2012.730550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Johansson EL, Ternesten-Hasséus E, Olsén MF, Millqvist E. Respiratory movement and pain thresholds in airway environmental sensitivity, asthma and COPD. Respir Med 2012; 106:1006-13. [PMID: 22510540 DOI: 10.1016/j.rmed.2012.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/01/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with "sensory hyperreactivity" (SHR) have airway environmental sensitivity, chronic cough and dyspnoea. Cough, chest discomfort and sense of difficulties getting air are some of the symptoms these patients seek medical attendance for. The patients have increased cough sensitivity to inhaled capsaicin, mediated by ion channel receptors on sensory nerves also known to react to pain stimuli. Whether a link exists between capsaicin airway sensitivity and pain sensitivity has not yet been evaluated. The aim was to investigate chest mobility, respiratory movement and pain sensitivity in SHR patients compared with patients with asthma, chronic obstructive pulmonary disease (COPD) and alleged healthy control subjects. METHODS Thirty-five patients diagnosed with SHR, 19 with COPD, 32 with asthma and 28 control subjects were included. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using a pressure algometer. RESULTS Groups differed significantly in lung function, respiratory rate and pain sensitivity but also in chest expansion and abdominal breathing movement. In comparison with the control and asthma groups but not the COPD patients, SHR patients had an increased respiratory rate and reduced abdominal movement during deep breathing. All patient groups showed lower pain thresholds than the controls. CONCLUSION Patients with SHR have evident signs of dysfunctional breathing and appeared to be most similar to the COPD group except for lung function. Lower pain thresholds among the patients indicate a general up-regulation of the sensory nerve system.
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Affiliation(s)
- Ewa-Lena Johansson
- Departments of Clinical Neuroscience and Rehabilitation, Physiotherapy, the Sahlgrenska Academy, University of Gothenburg, Sweden
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An Unusual Case of Suspected Microvascular Angina in a Newborn. Case Rep Pediatr 2012; 2012:879161. [PMID: 23119213 PMCID: PMC3483658 DOI: 10.1155/2012/879161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/30/2012] [Indexed: 11/17/2022] Open
Abstract
Myocardial ischemia in pediatric population is uncommon and usually due to congenital heart disease or extracardiac conditions leading to poor coronary perfusion. A 6-day-old newborn presented with respiratory distress and signs of heart failure. ECG, echocardiography, and laboratory results were consistent with myocardial ischemia. Coronary angiography was performed to exclude anomalous origin of coronary arteries, showing normal coronary artery origin and course. Thrombophilia and extra-cardiac causes were ruled out. Clinical conditions improved with mechanical ventilation and diuretics, enzyme levels lowered, repolarisation and systolic function abnormalities regressed, but ischemic electrocardiographic and echocardiographic signs still presented during intense crying. Becaues of suspicion of microvascular angina, therapy with ASA and beta-blocker was started. At 5 month followup, the baby was in good clinical condition and no more episodes were recorded. We believe it is an interesting case, as no similar cases have been recorded till now.
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Naidu OA, Rajasekhar D, Latheef SAA. Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease. Cardiovasc Ultrasound 2011; 9:40. [PMID: 22151947 PMCID: PMC3250931 DOI: 10.1186/1476-7120-9-40] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 12/09/2011] [Indexed: 11/15/2022] Open
Abstract
Background Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients. Methods We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control subjects. Results Significantly decreased flow mediated dilatation was observed in patients when compared to control (9.42 ± 7.20 vs 21.11 ± 9.16 p < 0.01) but no significant difference was observed between groups in response to nitroglycerin (25.39 ± 6.82 vs 28.87 ± 8.69). Receiver operator characteristic analysis showed that value of < 11.11 had sensitivity of 80%, specificity 86.67%, positive predictive value 76.66%, negative predictive value 83.33%. In total, 46% of subjects had endothelial dysfunction and of them, CSX subjects had higher prevalence (76% vs 16% p < 0.01) than control subjects. Higher mean values of body mass index, systolic blood pressure and diastolic blood pressure was observed in subjects with FMD < 11.11 than > 11.11(p < 0.01). In logistic regression analysis, FMD was significantly associated with systolic blood pressure (Odds ratio 1.122 95% CI 1.053-1.196 p < 0.01) and body mass index (Odds 1.248 95%CI 0.995-1.56 p < 0.05). Conclusions The study suggests impairment of endothelial function in cardiac syndrome X patients. Increased Systolic blood pressure and body mass index may increase the risk of impairment of endothelial function in this group of patients.
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Affiliation(s)
- Otikunta Adikesava Naidu
- Department of Cardiology, Osmania General Hospital and Osmania Medical College, Hyderabad, Andhra Pradesh, India.
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Cardiopulmonary exercise testing for the assessment of exercise capacity in patients with cardiac syndrome X. Int J Cardiol 2011; 154:85-7. [PMID: 22062894 DOI: 10.1016/j.ijcard.2011.10.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 10/18/2011] [Indexed: 11/20/2022]
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Dominguez-Rodriguez A, Abreu-Gonzalez P. Cardiac syndrome X: The pathophysiology should be expanded? Int J Cardiol 2011; 146:110-1; author reply 111-2. [DOI: 10.1016/j.ijcard.2010.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 09/26/2010] [Indexed: 11/24/2022]
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Singh M, Arora R, Khosla S. Cardiac syndrome X. Int J Cardiol 2011. [DOI: 10.1016/j.ijcard.2010.10.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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