Circulation, Vol 90, 50-60, Copyright © 1994 by American Heart Association
SD Rosen, NG Uren, JC Kaski, D Tousoulis, GJ Davies and PG Camici
BACKGROUND: It remains unclear whether myocardial ischemia due to coronary
microvascular dysfunction is the cause of chest pain in syndrome X (chest
pain, ischemic-like stress ECG despite angiographically normal coronary
arteries). To assess the function of the coronary microcirculation and its
relation to pain perception, we measured myocardial blood flow (MBF) and
coronary vasodilator reserve (CVR) in 29 patients with syndrome X and 20
matched normal control subjects. METHODS AND RESULTS: MBF at rest and after
intravenous dipyridamole (0.56 mg.kg-1 over 4 minutes) was measured using
positron emission tomography with H2(15)O. CVR was calculated as
MBFdipyridamole/MBFrest. ECG changes and chest pain after dipyridamole in
syndrome X were compared with those in 35 patients with coronary artery
disease (CAD). Resting and postdipyridamole MBFs were homogeneous
throughout the left ventricle in syndrome X patients and control subjects.
MBF was 1.05 (0.25), mean (SD) versus 1.00 (0.22) mL.min-1.g-1 (P = NS) at
rest and 2.73 (0.81) versus 3.00 (1.00) mL.min- 1.g-1 (P = NS) after
dipyridamole in patients and control subjects, respectively. CVRs were 2.66
(0.76) and 3.06 (1.08) (P = NS) and after correction of resting MBF for
rate-pressure product were 2.35 (0.83) and 2.34 (0.90) (P = NS) in patients
and control subjects, respectively. Female syndrome X patients had higher
resting MBF than males, at 1.18 (0.20) versus 0.88 (0.19) mL.min-1.g-1 (P
< .001). Chest pain after dipyridamole occurred in syndrome X as
frequently as in CAD (21/29 versus 22/35, P = NS). CONCLUSIONS: When
patients with syndrome X are compared with control subjects, no differences
are found in MBF either at rest or after dipyridamole, despite syndrome X
patients experiencing chest pain after dipyridamole to the same extent as
patients with CAD. These findings, together with the absence of any
relation among MBF, chest pain, and ECG changes under stress, cast further
doubt on ischemia as the basis of the chest pain, at least in the majority
of syndrome X patients.
ARTICLES
Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X
Cyclotron Unit, Medical Research Council Clinical Sciences Centre, Hammersmith Hospital, London, UK.
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