Circulation, Vol 89, 1998-2004, Copyright © 1994 by American Heart Association
A Chauhan, PA Mullins, MC Petch and PM Schofield
BACKGROUND: An impaired coronary flow reserve in syndrome X has been
demonstrated by many studies. Recently, however, a normal coronary flow
reserve in response to papaverine was reported, but the number of patients
in these studies was small. The aim of this study was to investigate
whether coronary flow reserve in response to intracoronary papaverine is
really impaired in syndrome X. METHODS AND RESULTS: We investigated 53
syndrome X patients (typical angina, a positive exercise test, and
completely normal coronary arteries on angiography) and 26 heart transplant
patients with normal coronary arteries (control group). All antianginal
medications were stopped 48 hours before the study. A 3.6F intracoronary
Doppler catheter was positioned in the proximal left anterior descending
coronary artery and was connected to a Millar velocimeter. The coronary
blood flow velocity at rest and in response to a hyperemic dose of
papaverine was measured. Coronary flow reserve was defined as the ratio of
hyperemic coronary blood flow velocity in response to papaverine and
resting coronary blood flow velocity. The coronary flow reserve (mean +/-
SD) in the syndrome X group was 2.72 +/- 1.39. The coronary flow reserve in
the control group was significantly higher at 5.22 +/- 1.26 (P < .01).
In both groups there was no significant difference in the heart rate or the
mean arterial pressure during the study. CONCLUSIONS: Our study shows that
coronary flow reserve in response to intracoronary papaverine is impaired
in syndrome X patients.
ARTICLES
Is coronary flow reserve in response to papaverine really normal in syndrome X?
Regional Cardiac Unit, Papworth Hospital, Cambridge, UK.
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