Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2011 May;12(5):322-7. doi: 10.2459/JCM.0b013e3283406479.
The causes of coronary microvascular dysfunction (CMVD) in patients with cardiac syndrome X (CSX) are largely unknown. Common cardiovascular risk factors (CVRFs) and increased markers of inflammation have been associated with CMVD in some studies, but their role in determining CMVD in CSX patients remains poorly known.
We studied 71 CSX patients (56 ± 9 years, 23 men) and 20 healthy volunteers (52 ± 7 years, nine men). Using transthoracic Doppler echocardiography, coronary microvascular vasodilator function was assessed in the left anterior descending coronary artery as the ratio of diastolic coronary blood flow (CBF) velocity at peak intravenous adenosine administration and during cold pressor test (CPT) to the respective basal CBF velocity values. Common CVRFs tended to be more frequent and C-reactive protein (CRP) levels were higher (P < 0.001) in CSX patients than in controls. Both CBF responses to adenosine (2.05 ± 0.6 vs. 2.92 ± 0.9, P < 0.001) and to CPT (1.71 ± 0.6 vs. 2.42 ± 0.7, P < 0.001) were lower in CSX patients than in controls. The differences between the two groups in CBF response to adenosine and in CBF response to CPT remained highly significant (P < 0.01 for both) after adjustment for all CVRFs, including serum CRP levels.
In CSX patients, both endothelium-dependent and endothelium-independent CMVD cannot be reliably predicted by CVRFs (including serum CRP levels), alone or in combination.
心脏综合征 X（CSX）患者冠状动脉微血管功能障碍（CMVD）的原因在很大程度上尚不清楚。一些研究表明，常见心血管危险因素（CVRF）和炎症标志物增加与 CMVD 相关，但它们在确定 CSX 患者 CMVD 中的作用仍知之甚少。
我们研究了 71 例 CSX 患者（56 ± 9 岁，23 名男性）和 20 名健康志愿者（52 ± 7 岁，9 名男性）。使用经胸多普勒超声心动图，通过静脉内注射腺苷时舒张期冠状动脉血流（CBF）速度与冷加压试验（CPT）时的 CBF 速度与各自基础 CBF 速度值的比值评估左前降支冠状动脉的冠状动脉微血管舒张功能。CSX 患者的常见 CVRF 往往更为频繁，C 反应蛋白（CRP）水平更高（P < 0.001）。与对照组相比，CSX 患者对腺苷（2.05 ± 0.6 对 2.92 ± 0.9，P < 0.001）和 CPT（1.71 ± 0.6 对 2.42 ± 0.7，P < 0.001）的 CBF 反应均较低。在调整所有 CVRF 后，包括血清 CRP 水平，CSX 患者对腺苷和 CPT 的 CBF 反应之间的差异仍然具有高度显著性（两者均 P < 0.01）。
在 CSX 患者中，仅通过 CVRF（包括血清 CRP 水平）不能可靠地预测内皮依赖性和非内皮依赖性 CMVD。
