Prevalence of Coronary Blood Flow Reserve Abnormalities Among Patients With Nonobstructive Coronary Artery Disease and Chest Pain
Section snippets
Study Protocol
The following study protocol was approved by the Mayo Clinic Institutional Review Board. The decision to refer patients for assessment of chest pain was at the discretion of the attending physician. All patients had recurrent chest pain suspected to be of cardiac origin. Exclusion criteria included more than 40% diameter stenosis of any coronary artery, prior myocardial infarction, unstable angina pectoris, uncontrolled hypertension, peripheral vascular disease, ejection fraction of 50% or
RESULTS
Between January 1993 and February 1997, 203 patients with nonobstructive coronary artery disease and chest pain were referred for assessment. Of these, 158 (77.8%) were female (Table 1). The mean age of the study population was 51 years (range, 17 to 78), with a mean of 55 years and 50 years for male and female patients, respectively. Eighty-one women were postmenopausal, of whom 35 were receiving supplemental estrogen therapy. Most patients (92%) had at least one risk factor for coronary
DISCUSSION
The current study demonstrates that abnormalities in endothelium-dependent and endothelium-independent coronary flow reserve are prevalent in most patients with nonobstructive coronary artery disease and chest pain referred for assessment. Most of this patient population had at least one risk factor for coronary artery disease. Our data also underscore the diversity of coronary flow reserve abnormalities in this patient population. Although the major abnormality was an impairment in coronary
CONCLUSION
This study in a large cohort of patients with risk factors for coronary artery disease, nonobstructive coronary artery disease, and chest pain demonstrates that diverse endothelium-dependent and endothelium-independent coronary flow reserve abnormalities may frequently be detected. This finding suggests that these patients should undergo a comprehensive evaluation of coronary flow reserve to guide their management.
REFERENCES (51)
- et al.
The anginal syndrome associated with normal coronary arteriograms: report of a six year experience
Am J Med
(1973) - et al.
Somatic and social prognosis of patients with angina pectoris and normal coronary arteriography: a follow-up study
IntJCardiot
(1993) - et al.
The effect of noncritical coronary artery disease on long-term survival
Am J Med Sei
(1995) - et al.
Long-term follow-up of patients initially diagnosed with syndrome X
Am J Cardiol
(1993) - et al.
Evidence that selective endothelial dysfunction may occur in the absence of angiographic or ultrasound atheroscletosis in patients with risk factors for atherosclerosis
J Am Coll Cardiol
(1994) - et al.
Angina caused by reduced vasodilator reserve of the small coronary arteries
J Am Coll Cardiol
(1983) - et al.
Correction of endothelial dysfunction in coronary microcircuiation of hypercholesterolaemic patients by Largini ne
Lancet
(1991) - et al.
Coronary vasomotion in response to sympathetic stimulation in humans: importance of the functional integrity of the endothelium
JAm Coll Cardiol
(1989) - et al.
Evaluation of patients with minimally obstructive coronary artery disease and angina
IntJ Cardiol
(1996) - et al.
Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction
J Am Coll Cardiol
(1994)
Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women
J Am Coll Cardiol
Acute myocardial infarction with normal coronary arteries associated with acetylcholine-induced vasoconstriction in the absence of a positive ergonovine test
Am J Cardiol
Hyperinsulinemia, coronary artery disease and syndrome X
J Am Coll Cardiol
Relation between clinical, angiographie and ischémie findings at baseline and ischemia-related adverse outcomes at 1 year in the Asymptomalrc Cardiac Ischemia Pilot Study
JAm Coll Cardiol
A reappraisal of exercise electrocardiograph^ indexes of the severity of ischémie heart disease: angiographie and scintigraphic correlates
J Am Coll Cardiol
Epicardial vasomotor responses to acetylcholine are not predicted by coronary atherosclerosis as assessed by intracoronary ultrasound
J Am Coll Cardiol
Selective cine coronary arteriography: correlation with clinical findings in 1,000 patients
Circulation
Psychological morbidity in patients with chest pain and normal or near-normal coronary arteries: a long term follow-up study
Psychol Med
Psychosocial outcome and use of medical resources in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study
Q JMed
Imipramine in patients with chest pain despite normal coronary angiograms
N Engl JMed
Unexplained chest pain with normal coronary arteriograms: a fotlow-up study of functional status
N Engl J Med
Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms
N EnglJMed
Variable coronary vasomotor responses to acetylchoüne in patients with normal coronary arteriograms: evidence for localised endothelial dysfunction
Heart
Effects of age on endothelium-dependent vasodilation of resistance coronary artery by acetylchoine in humans
Circulation
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This study was supported in part by Grant HL 03180-01 from the National Institutes of Health, Public Health Service, the Miami Heart Research Institute, The Bruce and Ruth Rappaport Vascular Biology Program, and the Mayo Foundation.
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Current address: Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.