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(Circulation. 2000;102:2359.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Endothelial Activation in Patients With Cardiac Syndrome X

Giovambattista Desideri, MD; Achille Gaspardone, MD; Marco Gentile, MD; Anna Santucci, MD; Pier Agostino Gioffrè, MD; Claudio Ferri, MD

From the Department of Internal Medicine and Public Health (G.D., M.G., A.S., C.F.), University of L’Aquila, L’Aquila, Italy; and Department of Cardiac Surgery (A.G., P.A.G.), University of Tor Vergata, Rome, Italy.

Correspondence to Giovambattista Desideri, MD, Università di L’Aquila, Dipartimento di Medicina Interna e Sanità Pubblica, Blocco 11, Via Vetoio, Coppito, 67100, L’Aquila, Italy. E-mail gbdesi{at}freemail.it

Background—The presence of endothelial dysfunction with increased endothelin-1 plasma concentrations in patients with cardiac syndrome X is still under debate. The aim of the present study was to evaluate the presence of endothelial dysfunction in patients with cardiac syndrome X.

Methods and Results—Endothelin-1 levels were evaluated with a sensitive radioimmunoassay with previous purification through reverse phase HPLC in 24 patients (3 men and 21 women, mean age 54±7 years) with typical angina, instrumental evidence of ischemia, and normal coronary angiograms both under baseline conditions and after oral glucose load (75 g D-glucose). We also measured plasma nitrite-plus-nitrate levels, a sharp index of endothelial nitric oxide production, and circulating concentrations of the soluble fraction of the endothelial adhesion molecule vascular cell adhesion molecule-1, a well-recognized marker of early endothelial dysfunction. Fourteen healthy subjects (1 man and 13 women, mean age 47±15 years) served as controls. There were no significant differences in baseline plasma endothelin-1 concentrations between patients and control subjects (0.55±0.34 versus 0.48±0.22 pg/mL, P=0.503). Plasma nitrite-plus-nitrate and soluble vascular cell adhesion molecule-1 concentrations were also similar between the 2 groups. After glucose ingestion, circulating endothelin-1 concentrations were significantly higher in patients with cardiac syndrome X than in control subjects (P<0.03 at 60, 90, and 120 minutes).

Conclusions—Our findings show that no basal endothelial damage is present in patients with cardiac syndrome X. Nevertheless, increased responsiveness of endothelin-1 to glucose loading suggests that patients with cardiac syndrome X present an increased susceptibility to releasing endothelin-1 under stressful circumstances.

Key Words: endothelin • cell adhesion molecules • endothelium-derived factors • angina

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