Sen Nihat, Poyraz Fatih, Tavil Yusuf, Yazici Hüseyin Ugur, Turfan Murat, Hizal Fatma, Topal Salih, Erdamar Hüsamettin, Cakir Erdinc, Yalçin Ridvan, Cengel Atiye
Department of Cardiology, Gazi University, School of Medicine, Besevler, Ankara, Turkey.
Atherosclerosis. 2009 Jun;204(2):e82-5. doi: 10.1016/j.atherosclerosis.2008.09.029. Epub 2008 Oct 8.
The cause of myocardial ischemia and chest pain in patients with cardiac syndrome X (CSX) has been explained by mechanisms including endothelial dysfunction. CSX patients have higher levels of asymmetric dimethylarginine (ADMA) and increased mean common carotid intima-media thickness (C-IMT). Accordingly, this study was designed to examine C-IMT with its association serum endothelial function parameters in patients with CSX.
The study population consisted of 30 enrolled consecutive patients with diagnosis of CSX. As a control group, 30 individuals with the complaint of anginal chest pain without any ischemia on myocardial perfusion scintigraphy and with normal coronary angiographies were selected. C-IMT was measured by recording ultrasonographic images of both the left and the right common carotid artery. Plasma levels of L-arginine, ADMA, and nitrate/nitrite (NO(x)) were measured from blood samples.
Both C-IMT (mm) and carotid atherosclerotic plaques were significantly higher in patients with CSX than in control group. Also, the plasma level of NO(x), L-arginine, and L-arginine/ADMA ratio were lower in patients with CSX than they were in the control group subjects. Plasma ADMA level increased in the CSX patients group. Correlation analysis showed significant positive correlation with C-IMT and plasma ADMA levels and showed significant negative correlation with plasma NO(x) and L-arginine levels. L-arginine/ADMA ratio and C-IMT was also showed significant negative correlation with the same analysis.
CSX patients had higher plasma ADMA levels and C-IMT values than the controls, reflecting the presence of subclinical atherosclerosis. These findings suggest that, besides endothelial dysfunction, presence of atherosclerosis may also contribute to the etiopathogenesis of the CSX phenomenon.
心脏X综合征（CSX）患者心肌缺血和胸痛的病因已通过包括内皮功能障碍在内的机制进行了解释。CSX患者的不对称二甲基精氨酸（ADMA）水平较高，平均颈总动脉内膜中层厚度（C-IMT）增加。因此，本研究旨在检测CSX患者的C-IMT及其与血清内皮功能参数的关联。
研究人群包括30例连续入选的确诊为CSX的患者。作为对照组，选择了30例有典型心绞痛胸痛症状、心肌灌注显像无任何缺血表现且冠状动脉造影正常的个体。通过记录左右颈总动脉的超声图像来测量C-IMT。从血样中测量血浆L-精氨酸、ADMA和硝酸盐/亚硝酸盐（NO(x)）的水平。
CSX患者的C-IMT（mm）和颈动脉粥样硬化斑块均显著高于对照组。此外，CSX患者的血浆NO(x)、L-精氨酸水平以及L-精氨酸/ADMA比值均低于对照组。CSX患者组的血浆ADMA水平升高。相关性分析显示，C-IMT与血浆ADMA水平呈显著正相关，与血浆NO(x)和L-精氨酸水平呈显著负相关。同样的分析还显示L-精氨酸/ADMA比值与C-IMT呈显著负相关。
CSX患者的血浆ADMA水平和C-IMT值高于对照组，反映了亚临床动脉粥样硬化的存在。这些发现表明，除了内皮功能障碍外，动脉粥样硬化的存在也可能促成CSX现象的发病机制。
