International Journal of Cardiology
Volume 137, Issue 2 , Pages 137-144 , October 2009

Coronary slow-flow causing transient myocardial hypoperfusion in patients with cardiac syndrome X: Long-term clinical and functional prognosis

  • Gabriele Fragasso

      Affiliations

    • Division of Cardiology, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
    • Corresponding Author InformationCorresponding author. Istituto Scientifico H San Raffaele, Cardiologia Clinica, Via Olgettina, 60, 20132 Milano, Italy. Tel.: +39 02 26437366; fax: +39 02 26437398.
  • ,
  • Sergio L. Chierchia

      Affiliations

    • Division of Cardiology, Villa Azzurra Hospital, Rapallo, Genova, Italy
  • ,
  • Francesco Arioli

      Affiliations

    • Division of Cardiology, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
  • ,
  • Orazio Carandente

      Affiliations

    • Division of Cardiology, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
    • Deceased 28-02-2006.
  • ,
  • Stefano Gerosa

      Affiliations

    • Division of Cardiology, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
  • ,
  • Mauro Carlino

      Affiliations

    • Division of Cardiology, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
  • ,
  • Altin Palloshi

      Affiliations

    • Division of Cardiology, Casa di cura Santa Rita, Milano, Italy
  • ,
  • Luigi Gianolli

      Affiliations

    • Department of Nuclear Medicine, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
  • ,
  • Giliola Calori

      Affiliations

    • Division of Cardiology, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
  • ,
  • Ferruccio Fazio

      Affiliations

    • Department of Nuclear Medicine, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy
    • INB-CNR, University of Milano-Bicocca, Italy
  • ,
  • Alberto Margonato

      Affiliations

    • Division of Cardiology, Istituto Scientifico San Raffaele, Università Vita/Salute, Milano, Italy

Received 4 March 2008 ,Revised 6 May 2008 ,Accepted 28 June 2008.

References 

  1. Kaski JC. Pathophysiology and management of patients with chest pain and normal coronary arteriograms (cardiac syndrome X). Circulation. 2004;109:568–572
  2. Tambe AA, Demany MA, Zimmerman HA, et al. Angina pectoris and slow-flow velocity of dye in coronary arteries — a new angiographic finding. Am Heart J. 1972;84:66–71
  3. Przybojewski JZ, Becker PH. Angina pectoris and acute myocardial infarction due to “slow-flow phenomenon” in nonatherosclerotic coronary arteries: a case report. Angiology. 1986;37:751–761
  4. Burckhartt BA, Mukerji V, Alpert MA. Coronary artery slow-flow associated with angina pectoris and hypotension: a case report. Angiology. 1998;49:483–487
  5. Van Lierde J, Vrolix M, Sionis D, et al. Lack of evidence for small vessel disease in a patient with “slow dye progression” in the coronary arteries. Catheter Cardiovasc Diagn. 1991;23:117–120
  6. Kapoor A, Goel PK, Gupta S. Slow coronary flow — a cause for angina with ST segment elevation and normal coronary arteries. A case report. Int J Cardiol. 1998;67:257–261
  7. Mosseri M, Yarom R, Gotsman MS, et al. Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation. 1986;74:964–972
  8. Mangieri E, Macchiarelli G, Ciavolella M, et al. Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Catheter Cardiovasc Diagn. 1996;37:375–381
  9. Chierchia S, Margonato A, Fragasso G, et al. Microvascular spasm can cause ischaemia in patients with normal coronary arteries. Circulation. 1990;82:III–248
  10. Cannon RO, Watson RM, Rosing DR, et al. Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol. 1983;1:1359–1373
  11. Legrand V, Hodgson JM, Bates ER, et al. Abnormal coronary flow reserve and abnormal radionuclide exercise test results in patients with normal coronary angiograms. J Am Coll Cardiol. 1985;6:1245–1253
  12. Camici PG, Gistri R, Lorenzoni R, et al. Coronary reserve and exercise ECG in patients with chest pain and normal coronary angiograms. Circulation. 1992;86:179–186
  13. Kemp HG. Left ventricular function in patients with anginal syndrome and normal coronary arteriograms. Am J Cardiol. 1973;32:375–376
  14. Dwyer EM, Wiener L, Cox JW. Angina pectoris in patients with normal and abnormal coronary arteriograms: hemodynamic and clinical aspects. Am J Cardiol. 1969;23:639–646
  15. Arbogast R, Bourassa MG. Myocardial function during atrial pacing in patients with angina pectoris and normal coronary arteriograms: comparison with patients having significant coronary artery disease. Am J Cardiol. 1973;32:257–263
  16. Schofield PM, Brooks ND, Bennett DH. Left ventricular dysfunction in patients with angina pectoris and normal coronary angiograms. Br Heart J. 1986;56:327–333
  17. Fragasso G, Chierchia SL, Pizzetti G, et al. Impaired left ventricular filling dynamics in patients with angina and angiographically normal coronary arteries: effect of beta-adrenergic blockade. Heart. 1997;77:32–39
  18. Fragasso G, Chierchia SL, Lu C, et al. Left ventricular dysfunction during dobutamine stress echocardiography in patients with syndrome X and positive myocardial perfusion scintigraphy. G Ital Cardiol. 1999;29:383–390
  19. Tweddel AC, Martin W, Hutton I. Thallium scans in syndrome X. Br Heart J. 1992;68:48–50
  20. Romeo F, Rosano GMC, Martuscelli E, et al. Long-term follow-up of patients initially diagnosed with syndrome X. Am J Cardiol. 1993;71:669–673
  21. Fragasso G, Rossetti E, Dosio F, et al. High prevalence of the thallium-201 reverse redistribution phenomenon in patients with syndrome X. Eur Heart J. 1996;17:1482–1487
  22. Dean JD, Jones CHJ, Hutchinson SJ, et al. Hyperinsulinemia and microvascular angina (syndrome X). Lancet. 1991;337:456–457
  23. Fragasso G, Chierchia SL, Rossetti E, et al. Abnormal myocardial glucose handling in patients with syndrome X: effect of beta-adrenergic blockade. G Ital Cardiol. 1997;27:1113–1120
  24. Piatti PM, Fragasso G, Monti LD, et al. Endothelial and metabolic characteristics of patients with angina and angiographically normal coronary arteries. J Am Coll Cardiol. 1999;34:1452–1460
  25. Panting JR, Gatehouse PD, Yang GZ, et al. Abnormal subendocardial perfusion in cardiac syndrome x detected by cardiovascular magnetic resonance imaging. New Engl J Med. 2002;346:1948–1953
  26. Buchthal SD, den Hollander JA, Bairey Merz N, et al. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms. New Engl J Med. 2000;342:829–835
  27. Quyyumi AA, Cannon RO, Panza JA, et al. Endothelial dysfunction in patients with chest pain and normal coronary arteries. Circulation. 1992;86:1864–1871
  28. Motz W, Vogt M, Rabenay O, et al. Evidence of endothelial dysfunction in coronary resistance vessels in patients with angina pectoris and normal coronary angiograms. Am J Cardiol. 1991;68:996–1003
  29. Egashira K, Inou T, Hirooka Y, et al. Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. New Engl J Med. 1993;328:1659–1664
  30. Piatti PM, Fragasso G, Monti LD, et al. Acute Intravenous l-arginine infusion decreases endothelin-1 levels and improves endothelial function in patients with angina pectoris and normal coronary arteriograms: correlation with asymmetric dimethylarginine levels. Circulation. 2003;28:429–436107
  31. Kemp HG, Kronmal RA, Vlietstra RE, et al. Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol. 1986;7:479–483
  32. Proudfit WL, Bruschke VG, Sones FM. Clinical course of patients with normal, slightly or moderately abnormal coronary arteriograms: 10 year follow-up of 521 patients. Circulation. 1980;62:712–717
  33. Isner JM, Salem DN, Banas J, et al. Long-term clinical course of patients with normal coronary arteriography: follow-up study of 121 patients with normal or nearly normal coronary arteriograms. Am Heart J. 1981;102:645–653
  34. Pasternak RC, Thibault GE, Savoia M, et al. Chest pain with angiographically insignificant coronary arterial obstruction. Clinical presentation and long-term follow-up. Am J Med. 1980;68:813–817
  35. Kaski JC, Rosano GMC, Collins P, et al. Cardiac syndrome X: clinical characteristics and left ventricular function: long-term follow-up study. J Am Coll Cardiol. 1995;25:807–814
  36. von Mering GO, Arant CB, Wessel TR, et al. Abnormal coronary vasomotion as a prognostic indicator of cardiovascular events in women: results from the National Heart, Lung, and Blood Institute-Sponsored Women's Ischemia Syndrome Evaluation (WISE). Circulation. 2004;109:722–725
  37. Suwaidi JA, Hamasaki S, Higano ST, et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000;101:948–954
  38. Johnson DB, Shaw LJ, Pepine CJ, et al. Persistent chest pain predicts cardiovascular events in women without obstructive coronary artery disease: results from the NIH-NHLBI-sponsored Women's Ischaemia Syndrome Evaluation (WISE) study. Eur Heart J. 2006;27:1408–1415
  39. Bugiardini R, Manfrini O, Pizzi C, et al. Endothelial function predicts future development of coronary artery disease: a study on women with chest pain and normal angiograms. Circulation. 2004;109:2518–2523
  40. Lanza GA, Manzoli A, Biasucci E, et al. Acute effects of nitrates on exercise testing in patients with syndrome X. Clinical and pathophysiological implications. Circulation. Dec 1994;90(6):2695–2700
  41. Radice M, Giudici V, Albertini A, et al. Usefulness of changes in exercise tolerance induced by nitroglycerin in identifying patients with syndrome X. Am Heart J. Mar 1994;127(3):531–535
  42. Feletou M, Vanhoutte PM. Endothelium-dependent hyperpolarization of canine coronary smooth muscle. Br J Pharmacol. 1987;92:657–664
  43. Lerman A, Webster MW, Chesebro JH, et al. Circulating and tissue endothelin immunoreactivity in hypercholesterolemic pigs. Circulation. 1993;88:2923–2928
  44. Cannon RO. Chest pain with normal coronary angiograms. New Engl J Med. 1993;328:1706–1708
  45. Coats AJ. Ethical authorship and publishing. Int J Cardiol. 2009;131:149–150

PII: S0167-5273(08)00833-4

doi: 10.1016/j.ijcard.2008.06.070

International Journal of Cardiology
Volume 137, Issue 2 , Pages 137-144 , October 2009