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Civieri G, Kerkhof PLM, Montisci R, Iliceto S, Tona F. Sex differences in diagnostic modalities of coronary artery disease: Evidence from coronary microcirculation. Atherosclerosis 2023; 384:117276. [PMID: 37775426 DOI: 10.1016/j.atherosclerosis.2023.117276] [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: 03/24/2023] [Revised: 06/16/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
Although atherosclerosis is usually considered a disease of the large arteries, risk factors for atherosclerosis also trigger structural and functional abnormalities at a microvascular level. In cardiac disease, microvascular dysfunction is especially relevant in women, among whom the manifestation of ischemic disease due to impaired coronary microcirculation is more common than in men. This sex-specific clinical phenotype has important clinical implications and, given the higher pre-test probability of coronary microvascular dysfunction in females, different diagnostic modalities should be used in women compared to men. In this review, we summarize invasive and non-invasive diagnostic modalities to assess coronary microvascular function, ranging from catheter-based evaluation of endothelial function to Doppler echocardiography and positron emission tomography. Moreover, we discuss different clinical settings in which microvascular disease plays an important role, underlining the importance of choosing the right diagnostic modality depending on the sex of the patients.
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Affiliation(s)
- Giovanni Civieri
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Peter L M Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VUmc, Amsterdam, the Netherlands
| | - Roberta Montisci
- Clinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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2
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Chen XY, Yang QM, Fang JX, Guo HF. The Value of Three-Dimensional Speckle-Tracking Echocardiography in the Prediction of Cardiovascular Events in Patients with Hypertension Complicated by Acute Myocardial Infarction: A Long-Term Follow-Up Study. Int J Gen Med 2021; 14:6703-6712. [PMID: 34675631 PMCID: PMC8520435 DOI: 10.2147/ijgm.s330789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Patients with hypertension complicated by acute myocardial infarction (AMI) have a generally poor prognosis. The identification of powerful predictors for recurring cardiovascular events (RCEs) is vital. This study seeks to evaluate the predictive value of three-dimensional (3D) strain parameters for RCEs in patients with hypertension complicated by AMI. Methods We successfully followed up patients with hypertension and AMI from April 2015 to December 2015 in this retrospective study. Participants previously underwent 3D echocardiography, one week, and one month after percutaneous coronary intervention (PCI). The left ventricular structural function parameters, as well as 3D strain parameters including 3D global longitudinal strain (3D-GLS), 3D global circumferential strain, 3D global radial strain, and 3D global area strain (3D-GAS), were acquired. A Cox model was used to determine the relationships between these parameters and RCEs. Results In total, 62 patients were enrolled in the analysis. During follow-up (41.27 ± 20.45 months), 20 patients (32.3%) had RCEs that were independently predicted one month after PCI by 3D-GLS (HR: 1.481, 95% CI: 1.202–1.824, P < 0.001) and 3D-GAS (HR: 1.254, 95% CI: 1.093–1.440, P = 0.001). The optimal cutoffs for 3D-GLS and 3D-GAS in predicting cardiac events were ≥12.5% (area under the receiver operating characteristic curve [AUC]: 0.736, 95% CI: 0.611–0.862, P = 0.003), and >20.5% (AUC: 0.685, 95% CI: 0.551–0.818, P = 0.020), respectively. Conclusion The assessed values of 3D-GLS and 3D-GAS one month after PCI can predict RCEs in patients with hypertension complicated by AMI.
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Affiliation(s)
- Xiao-Yan Chen
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, People's Republic of China.,Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qing-Mei Yang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, People's Republic of China.,Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jian-Xiu Fang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, People's Republic of China.,Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Hai-Feng Guo
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, People's Republic of China.,Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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3
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Aslan G, Polat V, Bozcali E, Opan S, Çetin N, Ural D. Evaluation of serum sST2 and sCD40L values in patients with microvascular angina. Microvasc Res 2018; 122:85-93. [PMID: 30502363 DOI: 10.1016/j.mvr.2018.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Coronary microvascular dysfunction plays a major role in the pathogenesis of microvascular angina (MVA). Along with endothelial dysfunction, microvascular atherosclerosis and inflammation seem to contribute to the development of coronary microvascular dysfunction. Serum soluble ST2 (sST2) and serum soluble CD40 ligand (sCD40L) are two biomarkers associated with inflammation and atherosclerosis. The aim of this study was to investigate the role of these biomarkers in the pathogenesis of MVA and determine their possible association with coronary microvascular dysfunction. METHODS A total of 152 patients were included in the study. Ninety-one patients with MVA {median age 56 years (40-79), of which 55 are women} and sixty-one controls {median age 52 (38-76), of which 29 are women} were included in the study. Serum concentration of sST2 and sCD40L were measured with a commercially available ELISA kit. RESULTS Serum sST2 (median 13.6 ng/ml; interquartile range (IQR), 3.5-63.8 ng/ml vs median 10.6 ng/ml; IQR, 2.9-34.2 ng/ml, p < 0.0005) and sCD40L (median 5.3 ng/ml; IQR, 0.5-20.6 ng/ml vs median 2.2 ng/ml; IQR, 0.7-10.8 ng/ml, p < 0.0005) were significantly higher in patients with MVA compared to controls. Analysis of the associations between these biomarkers and potential contributors of MVA revealed that serum sST2 showed a positive correlation with LDL-cholesterol (r = 0.19, p = 0.016) and serum sCD40L concentrations correlated positively with hs-CRP (r = 0.22, p = 0.005). In logistic regression analysis, sCD40L and hs-CRP but not sST2 were found to be significantly associated with MVA. CONCLUSION Higher serum concentrations of sST2 and sCD40L in MVA patients may be associated with inflammatory activation and coronary microvascular dysfunction. Larger studies are required for understanding their role in the pathogenesis of inflammatory and possibly fibrotic process in MVA patients.
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Affiliation(s)
- Gamze Aslan
- Department of Cardiology, Koc University School of Medicine and Hospital, Istanbul, Turkey.
| | - Veli Polat
- Department of Cardiology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Evin Bozcali
- Department of Cardiology, Koc University School of Medicine and Hospital, Istanbul, Turkey
| | - Selçuk Opan
- Department of Cardiology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Nurcan Çetin
- Duzen Laboratory, Cemal Sahir Sok. No: 14, 34383 Mecidiyekoy, Istanbul, Turkey
| | - Dilek Ural
- Department of Cardiology, Koc University School of Medicine and Hospital, Istanbul, Turkey
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Kilic-Toprak E, Yaylali O, Yaylali YT, Ozdemir Y, Yuksel D, Senol H, Sengoz T, Bor-Kucukatay M. Hemorheological dysfunction in cardiac syndrome X. Acta Cardiol 2018; 73:257-265. [PMID: 28889793 DOI: 10.1080/00015385.2017.1373967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac syndrome X (CSX) is often described as angina or angina-like chest pain with a normal coronary arteriogram, yet the underlying pathophysiological mechanisms have not been fully elucidated. The aim of the current study was to determine alterations in blood rheology (erythrocyte aggregation and deformability, plasma viscosity - PV) in patients with CSX. METHODS The study comprised 26 CSX patients (55.77 ± 12.33 years) and 37 age- and sex-matched (56.32 ± 11.98 years) healthy controls. Erythrocyte aggregation and deformability were measured by an ektacytometer and PV with a rotational viscometer. RESULTS Erythrocyte deformability measured at 1.69 and 3.00 Pa was lower in the CSX patients compared to the controls (p = .0001 and .017, respectively). Erythrocyte aggregation index (AI) (72.758 ± 7.65 vs. 66.483 ± 6.63, p = .002) and PV measured at a shear rate of 375 s-1 (1.932 ± 0.225 vs. 1.725 ± 0.331, p = .019) were significantly higher in patients with CSX. When AI, RDW and erythrocyte deformability measured at 1.69 Pa were evaluated together, it was observed that the increase in AI and RDW augments the risk of having CSX (OR: 1.2 and 2.65, respectively), while the rise in deformability decreases this risk (OR = 0.02). CONCLUSIONS Hemorheological impairments are associated with CSX.
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Affiliation(s)
- Emine Kilic-Toprak
- Faculty of Medicine, Department of Physiology, Pamukkale University, Kinikli, Denizli, Turkey
| | - Olga Yaylali
- Faculty of Medicine, Department of Nuclear Medicine, Pamukkale University, Kinikli, Denizli, Turkey
| | - Yalin Tolga Yaylali
- Faculty of Medicine, Department of Cardiology, Pamukkale University, Kinikli, Denizli, Turkey
| | - Yasin Ozdemir
- Faculty of Medicine, Department of Physiology, Pamukkale University, Kinikli, Denizli, Turkey
| | - Dogangun Yuksel
- Faculty of Medicine, Department of Nuclear Medicine, Pamukkale University, Kinikli, Denizli, Turkey
| | - Hande Senol
- Faculty of Medicine, Department of Biostatistics, Pamukkale University, Kinikli, Denizli, Turkey
| | - Tarık Sengoz
- Faculty of Medicine, Department of Nuclear Medicine, Pamukkale University, Kinikli, Denizli, Turkey
| | - Melek Bor-Kucukatay
- Faculty of Medicine, Department of Physiology, Pamukkale University, Kinikli, Denizli, Turkey
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5
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Ford TJ, Corcoran D, Berry C. Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need. HEART (BRITISH CARDIAC SOCIETY) 2017; 104:284-292. [PMID: 29030424 PMCID: PMC5861393 DOI: 10.1136/heartjnl-2017-311446] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 12/13/2022]
Abstract
The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease—INOCA). We review new insights into the pathophysiology of angina whereby myocardial ischaemia results from a deficient supply of oxygenated blood to the myocardium, due to various combinations of focal or diffuse epicardial disease (macrovascular), microvascular dysfunction or both. Macrovascular disease may be due to the presence of obstructive CAD secondary to atherosclerosis, or may be dynamic due to a functional disorder (eg, coronary artery spasm, myocardial bridging). Pathophysiology of coronary microvascular disease may involve anatomical abnormalities resulting in increased coronary resistance, or functional abnormalities resulting in abnormal vasomotor tone. We consider novel clinical diagnostic techniques enabling new insights into the causes of angina and appraise the need for improved therapeutic options for patients with INOCA. We conclude that the taxonomy of stable CAD could improve to better reflect the heterogeneous pathophysiology of the coronary circulation. We propose the term ‘stable coronary syndromes’ (SCS), which aligns with the well-established terminology for ‘acute coronary syndromes’. SCS subtends a clinically relevant classification that more fully encompasses the different diseases of the epicardial and microvascular coronary circulation.
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Affiliation(s)
- Thomas J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.,University of New South Wales, Sydney, NSW, Australia
| | - David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.,British Society of Cardiovascular Research, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.,British Society of Cardiovascular Research, Glasgow, UK
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6
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Kuruvilla S, Kramer CM. Coronary microvascular dysfunction in women: an overview of diagnostic strategies. Expert Rev Cardiovasc Ther 2014; 11:1515-25. [PMID: 24160578 DOI: 10.1586/14779072.2013.833854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Coronary microvascular dysfunction (CMD) also known as syndrome X, is characterized by typical anginal symptoms, evidence of myocardial ischemia on non-invasive testing and normal to minimal coronary disease on coronary angiography. It has a female preponderance and has been detected in up to 50% of women presenting with chest pain symptoms. Definitive diagnosis of CMD is critical as recent evidence suggests that women with this condition are at increased risk of cardiovascular events in the future. Invasive coronary reactivity testing on coronary angiography is considered to be the 'gold standard' for diagnosis of CMD. Non-invasive imaging techniques such as PET and cardiac magnetic resonance hold promise for detection of CMD in the future.
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Affiliation(s)
- Sujith Kuruvilla
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA and
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7
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Gil-Ortega I, Marzoa Rivas R, Ríos Vázquez R, Kaski JC. Role of inflammation and endothelial dysfunction in the pathogenesis of cardiac syndrome X. Future Cardiol 2012; 2:63-73. [PMID: 19804133 DOI: 10.2217/14796678.2.1.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chest pain with normal coronary arteriograms represents a major diagnostic and therapeutic challenge to contemporary cardiology. Cardiac syndrome X (CSX), defined as typical angina-like chest pain, a positive response to exercise stress testing and normal coronary arteriograms, encompasses patients with a variety of pathogenic mechanisms. Cardiac ischemia has been documented in approximately 25% of CSX patients and is associated with endothelial dysfunction and microvascular vasodilator abnormalities. Increased endothelin-1, a powerful vasoconstrictor, has been suggested to play a pathogenic role. There is a high prevalence of postmenopausal women with CSX and thus estrogen deficiency has also been proposed to represent a possible pathogenic mechanism. Inflammatory mechanisms and endothelial dysfunction at the coronary microvascular level appear to be important in the pathogenesis of CSX. Treatment with agents that have protective effects on the vasculature and also anti-inflammatory properties, such as statins and angiotensin-converting enzyme inhibitors have been effective in improving both symptoms and electrocardiographic signs of myocardial ischemia in patients with CSX. This review discusses the roles for endothelial dysfunction and inflammation in the pathogenesis of CSX, as well as the potential therapeutic implications of these mechanisms.
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Affiliation(s)
- Ignacio Gil-Ortega
- Coronary Artery Disease Research Unit, Cardiovascular Biology Research Centre, Division of Cardiac and Vascular Sciences,St. George s, University of LondonLondon, UK
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8
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Vermeltfoort IAC, Raijmakers PGHM, Riphagen II, Odekerken DAM, Kuijper AFM, Zwijnenburg A, Teule GJJ. Definitions and incidence of cardiac syndrome X: review and analysis of clinical data. Clin Res Cardiol 2010; 99:475-81. [PMID: 20407906 PMCID: PMC2911526 DOI: 10.1007/s00392-010-0159-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 04/07/2010] [Indexed: 01/18/2023]
Abstract
There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta-analysis yielded a pooled proportion of females of 0.56 (n = 1,934 patients, with 95% confidence interval: 0.54-0.59). As much as 9 inclusion criteria and 43 exclusion criteria were found in the 57 articles. Applying these criteria to a population with normal coronary angiograms and treated in 1 year at a general hospital, the attributable CSX incidence varied between 3 and 11%. The many inclusion and exclusion criteria result in a wide range of definitions of CSX and these have large effects on the incidence. This shows the need for a generally accepted definition of CSX.
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Affiliation(s)
- I A C Vermeltfoort
- Department of Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, The Netherlands.
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Affiliation(s)
- Charlie S. Thompson
- From the Division of Neurology, University of Ottawa, Neuroscience Research, The Ottawa Health Research Institute, the Canadian Stroke Network, and The Heart & Stroke Foundation Centre for Stroke Recovery, Ottawa, Ontario, Canada
| | - Antoine M. Hakim
- From the Division of Neurology, University of Ottawa, Neuroscience Research, The Ottawa Health Research Institute, the Canadian Stroke Network, and The Heart & Stroke Foundation Centre for Stroke Recovery, Ottawa, Ontario, Canada
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10
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Gur M, Yildiz A, Demirbag R, Yilmaz R, Aslan M, Ozdogru I, Erel O. Paraoxonase and arylesterase activities in patients with cardiac syndrome X, and their relationship with oxidative stress markers. Coron Artery Dis 2007; 18:89-95. [PMID: 17301599 DOI: 10.1097/mca.0b013e32801104e8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Paraoxonase-1 is a high-density lipoprotein-associated enzyme with three activities, which are paraoxonase, arylesterase and dyazoxonase. Paraoxonase-1 was shown to decrease in patients with cardiovascular diseases. We aimed to examine serum paraoxonase and arylesterase activities, and their relation with oxidative stress markers such as lipid hydroperoxide and total antioxidant status in patients with cardiac syndrome X. METHODS Forty-one consecutive patients with cardiac syndrome X (CSX group), 33 consecutive patients without cardiac syndrome X (non-cardiac syndrome X group) and 20 healthy volunteers as control group were taken into the study. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. Lipid hydroperoxide levels were measured by ferrous oxidation with xylenol orange assay. Total antioxidant status was determined using an automated measurement method. RESULTS Basal paraoxonase, salt-stimulated paraoxonase and arylesterase activities were significantly lower in patients with cardiac syndrome X than those of the non-cardiac syndrome X and control groups (P<0.001, for both). Moreover, lipid hydroperoxide was found at high level, and total antioxidant status was found at low level in patients with cardiac syndrome X than control and non-cardiac syndrome X groups (P<0.001, for all). In patients with cardiac syndrome X, in multiple linear regression analysis, both paraoxonase and arylesterase activities were independently correlated with lipid hydroperoxide levels (P=0.001, P=0.003, respectively), and also arylesterase activity was independently correlated with magnitude of ST depression (P=0.002). CONCLUSION Reduced paraoxonase and arylesterase activities and total antioxidant status levels and enhanced lipid hydroperoxide levels in patients with cardiac syndrome X might indicate increased oxidative stress that can play a role in pathogenesis of cardiac syndrome X.
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Affiliation(s)
- Mustafa Gur
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey.
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11
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Gapelyuk A, Wessel N, Fischer R, Zacharzowsky U, Koch L, Selbig D, Schütt H, Sawitzki B, Luft FC, Dietz R, Schirdewan A. Detection of patients with coronary artery disease using cardiac magnetic field mapping at rest. J Electrocardiol 2007; 40:401-7. [PMID: 17531250 DOI: 10.1016/j.jelectrocard.2007.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2006] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
We studied the use of cardiac magnetic field mapping to detect patients with CAD without subjecting them to stress. Fifty-nine healthy control subjects and 101 patients with CAD without previous MI were included. The optimal positions for detecting CAD were located in the left superior parasternal and in the inferior midsternal area. Values for ST slope, ST shift, T peak amplitude, ST-T integral, and magnetic field map orientation differed significantly between the 2 groups. Three parameters together in a multivariate analysis yielded a sensitivity of 84% and a specificity of 83% in distinguishing patients with CAD from control subjects. We suggest that cardiac magnetic field mapping is a promising technique to identify patients with CAD.
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Affiliation(s)
- Andrej Gapelyuk
- Medical Faculty of the Charité, Franz Volhard Klinik, Helios Klinikum-Berlin, Berlin, Germany
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12
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Gur M, Yildiz A, Demirbag R, Yilmaz R, Koçyigit A, Celik H, Aksoy N. Increased lymphocyte deoxyribonucleic acid damage in patients with cardiac syndrome X. Mutat Res 2007; 617:8-15. [PMID: 17261316 DOI: 10.1016/j.mrfmmm.2006.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 06/30/2006] [Accepted: 08/26/2006] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To investigate whether there is lymphocyte deoxyribonucleic acid (DNA) damage in patients with cardiac syndrome X (CSX), and its relation with total antioxidant status (TAS), inflammation and ischemia. METHODS Twenty-three patients with CSX, 21 patients with non-CSX (NCSX) and 20 healthy volunteers were included in the study. Lymphocyte DNA damage (Arbitrary Unit) was assessed by alkaline single cell electrophoresis (comet) assay in peripheral lymphocyte, and plasma levels of TAS (mmol Trolox equiv./l) were determined using a novel automated measurement method. High sensitive C-reactive protein (hsCRP) and other biochemical parameters were measured from all subjects. Treadmill exercise test and coronary angiography were performed to CSX and NCSX groups. RESULTS Lymphocyte DNA damage was increased in patients with CSX compared with NCSX and control group (p<0.001, for both). Also, TAS was decreased, and hsCRP was increased in CSX compared with NCSX and control group (p<0.001, for all). Lymphocyte DNA damage was correlated with magnitude of ST depression (p=0.034), hsCRP (p=0.001), TAS (p<0.001) and presence of diabetes (p=0.022) in bivariate analysis. In multiple linear regression analysis, lymphocyte DNA damage was correlated with only TAS (beta=-0.413, p=0.017) and hsCRP (beta=0.414, p=0.006). CONCLUSION Lymphocyte DNA damage was increased in patients with CSX. The increase in lymphocyte DNA damage may be related with increased oxidative stress and inflammation in patients with CSX.
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Affiliation(s)
- Mustafa Gur
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, Turkey.
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13
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Mende A, Takano H, Kodama Y, Nakamura T, Umetani K, Fujioka D, Saito Y, Kobayashi T, Kawabata KI, Obata JE, Kitta Y, Kugiyama K. Relation between transcardiac gradient of VEGF and coronary flow response in humans. Int J Cardiol 2006; 119:156-62. [PMID: 17067705 DOI: 10.1016/j.ijcard.2006.07.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 07/15/2006] [Accepted: 07/17/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Angiogenic growth factors, produced in the myocardium and coronary vascular bed, increase myocardial blood flow. This study examined whether plasma levels of vascular endothelial growth factor (VEGF) in coronary circulation may be related to coronary blood flow responses. METHODS Blood flow responses in the left anterior descending coronary artery to an intracoronary infusion of acetylcholine (ACh) were measured by an intracoronary flow wire technique in 46 consecutive control subjects with normal coronary angiograms and left ventriculograms. Circulating VEGF levels were measured by ELISA in plasma obtained from the aortic root (AO) and anterior interventricular vein (AIV). RESULTS The transcardiac gradient of VEGF, calculated by the difference in VEGF concentrations between the AIV and AO, showed a positive correlation with the coronary blood flow increase in response to ACh independently of traditional coronary risk factors. In patients with cardiac syndrome X (n=17), defined as a positive exercise stress test with a normal coronary angiograms and left ventriculogram, the transcardiac VEGF gradient was significantly lower than in the risk factors-matched control subjects (n=21). CONCLUSIONS The transcardiac gradient of plasma VEGF was independently and positively correlated with the coronary blood flow increase in response to ACh. A reduced transcardiac VEGF gradient was present in cardiac syndrome X, a condition with a blunted coronary blood flow response.
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Affiliation(s)
- Akira Mende
- Department of Internal Medicine II, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, 1110 Shimokato, Nakakoma-gun, Yamanashi, 409-3898, Japan
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Abstract
The endomyocardial biopsy (EMB) remains the gold standard mode of investigation for diagnosing many primary and secondary cardiac conditions. Through a percutaneous and transvenous route, tissue fragments are generally procured from the right ventricular septum, with very few complications. Widespread use of EMB followed the development of heart transplantation as a means to follow allograft rejection. It has since been useful in helping to diagnose conditions affecting the heart, including cardiomyopathies, myocarditis, infiltrative lesions, arrhythmias, and drug toxicities. The procedure has also been used as a research tool to investigate the natural history of disease and the cardiotoxicity of new medications. This review presents an approach to the evaluation of the EMB, which is particularly directed towards those who may be asked to interpret such biopsies, but are not dedicated cardiovascular pathologists. Through a systematic evaluation of the endocardium, myocardium, interstitium, and intramural vessels, in the context of a complete clinical history, enough information can be deduced to diagnose or exclude specific conditions of clinical value.
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Affiliation(s)
- K S Cunningham
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario M5G 2CA, Canada
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On YK, Park R, Hyon MS, Kim SK, Kwon YJ. Are low total serum antioxidant status and elevated levels of C-reactive protein and monocyte chemotactic protein-1 associated with cardiac syndrome X? Circ J 2005; 69:1212-7. [PMID: 16195619 DOI: 10.1253/circj.69.1212] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac syndrome X, also known as microvascular angina, is characterized by exercise-induced chest pain occurring despite a normal coronary angiogram. Several causes and mechanisms have been proposed to explain both the chest pain and ST segment depression. In this study, the association, if any, between cardiac syndrome X and several factors, including blood total antioxidant status, C-reactive protein (CRP), and monocyte chemotactic protein-1 (MCP-1) levels, was investigated. METHODS AND RESULTS The study group comprised 36 patients who had been diagnosed as cardiac syndrome X on the basis of a positive treadmill test and a normal coronary angiogram, and 24 control patients. Total serum antioxidant status and CRP were assessed, and the levels of P-selectin, MCP-1, and interleukins 6 and 10 were also measured. Total serum antioxidant levels were determined to be significantly lower in the cardiac syndrome X patients than in the controls. CRP and serum MCP-1 levels, however, were found to be significantly higher in the cardiac syndrome X group. The total serum antioxidant levels and serum MCP-1 levels were comparable with the levels observed in a group of chronic stable angina patients. CONCLUSIONS In the present study, patients who had been diagnosed as cardiac syndrome X demonstrated increased systemic oxidative and enhanced inflammatory status.
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Affiliation(s)
- Young Keun On
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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