Skip to main content
Erschienen in: Current Cardiology Reports 2/2016

01.02.2016 | Ischemic Heart Disease (D Mukherjee, Section Editor)

Angina Pectoris and Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease: Role of Diagnostic Tests

verfasst von: Gaetano Antonio Lanza

Erschienen in: Current Cardiology Reports | Ausgabe 2/2016

Einloggen, um Zugang zu erhalten

Abstract

Patients with chest pain and nonobstructive coronary artery disease (NO-CAD) at angiography constitute a heterogeneous population. In most patients with stable exercise-induced chest pain, microvascular angina (MVA) is the likely diagnosis. Some clinical findings and results of diagnostic tests suggest that angina is caused by coronary microvascular (CMV) dysfunction rather than obstructive CAD, but a definitive diagnosis requires demonstration of impaired CMV dilation and/or increased constriction. About 10 % of patients presenting with an acute coronary syndrome also shows NO-CAD at angiography, and CMV constriction can be responsible for the syndrome in a number of cases. Diagnostic tests are not expected to have a prognostic role in patients with stable MVA with normal coronary arteries, due to the excellent prognosis of these patients, whereas their prognostic role in the more general population of NO-CAD patients with chest pain (either stable or acute) needs to be established in adequate studies.
Literatur
1.
Zurück zum Zitat Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362:886–95.PubMedCentralCrossRefPubMed Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362:886–95.PubMedCentralCrossRefPubMed
2.••
Zurück zum Zitat Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131:861–70. A review of studies about features and outcome of patients with acute coronary syndromes and non obstructive coronary atherosclerosis.CrossRefPubMed Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131:861–70. A review of studies about features and outcome of patients with acute coronary syndromes and non obstructive coronary atherosclerosis.CrossRefPubMed
4.
Zurück zum Zitat Cannon 3rd RO, Epstein SE. “Microvascular angina” as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol. 1988;61:1338–43.CrossRefPubMed Cannon 3rd RO, Epstein SE. “Microvascular angina” as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol. 1988;61:1338–43.CrossRefPubMed
5.
Zurück zum Zitat Lanza GA, Crea F. Primary coronary microvascular dysfunction: clinical presentation, pathophysiology, and management. Circulation. 2010;121:2317–25.CrossRefPubMed Lanza GA, Crea F. Primary coronary microvascular dysfunction: clinical presentation, pathophysiology, and management. Circulation. 2010;121:2317–25.CrossRefPubMed
6.
Zurück zum Zitat Cannon 3rd RO. Microvascular angina. Cardiovascular investigations regarding pathophysiology and management. Med Clin North Am. 1991;75:1097–118.PubMed Cannon 3rd RO. Microvascular angina. Cardiovascular investigations regarding pathophysiology and management. Med Clin North Am. 1991;75:1097–118.PubMed
7.•
Zurück zum Zitat Ong P, Athanasiadis A, Borgulya G, Vokshi I, Bastiaenen R, Kubik S, et al. Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries. Circulation. 2014;129:1723–30. A large study about the effects of intracoronary acetylcholine in patients with chest pain and non obstructive coronary atherosclerosis.CrossRefPubMed Ong P, Athanasiadis A, Borgulya G, Vokshi I, Bastiaenen R, Kubik S, et al. Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries. Circulation. 2014;129:1723–30. A large study about the effects of intracoronary acetylcholine in patients with chest pain and non obstructive coronary atherosclerosis.CrossRefPubMed
8.
Zurück zum Zitat Weiner DA, McCabe C, Hueter DC, Ryan TJ, Hood Jr WB. The predictive value of anginal chest pain as an indicator of coronary disease during exercise testing. Am Heart J. 1978;96:458–62.CrossRefPubMed Weiner DA, McCabe C, Hueter DC, Ryan TJ, Hood Jr WB. The predictive value of anginal chest pain as an indicator of coronary disease during exercise testing. Am Heart J. 1978;96:458–62.CrossRefPubMed
9.
Zurück zum Zitat Di Franco A, Milo M, Laurito M, Nerla R, Lanza GA. Comparisons of clinical and angina characteristics between patients with cardiac syndrome X and patients with coronary artery disease. It J Practice Cardiol. 2012;1:15–21. www.ancecardio.it. Di Franco A, Milo M, Laurito M, Nerla R, Lanza GA. Comparisons of clinical and angina characteristics between patients with cardiac syndrome X and patients with coronary artery disease. It J Practice Cardiol. 2012;1:15–21. www.​ancecardio.​it.
10.
Zurück zum Zitat Pupita G, Kaski JC, Galassi AR, Gavrielides S, Crea F, Maseri A. Similar time course of ST depression during and after exercise in patients with coronary artery disease and syndrome X. Am Heart J. 1990;120:848–54.CrossRefPubMed Pupita G, Kaski JC, Galassi AR, Gavrielides S, Crea F, Maseri A. Similar time course of ST depression during and after exercise in patients with coronary artery disease and syndrome X. Am Heart J. 1990;120:848–54.CrossRefPubMed
11.
Zurück zum Zitat Burton P, Kaski JC, Maseri A. A combination of electrocardiographic methods represents a further step toward the noninvasive identification of patients with syndrome X. Am Heart J. 1992;123:53–8.CrossRefPubMed Burton P, Kaski JC, Maseri A. A combination of electrocardiographic methods represents a further step toward the noninvasive identification of patients with syndrome X. Am Heart J. 1992;123:53–8.CrossRefPubMed
12.
Zurück zum Zitat Kaski JC, Crea F, Nihoyannopoulos P, Hackett D, Maseri A. Transient myocardial ischemia during daily life in patients with syndrome X. Am J Cardiol. 1986;58:1242–7.CrossRefPubMed Kaski JC, Crea F, Nihoyannopoulos P, Hackett D, Maseri A. Transient myocardial ischemia during daily life in patients with syndrome X. Am J Cardiol. 1986;58:1242–7.CrossRefPubMed
13.
Zurück zum Zitat Lanza GA, Stazi F, Colonna G, Pedrotti P, Manzoli A, Crea F, et al. Circadian variation of ischemic threshold in syndrome X. Am J Cardiol. 1995;75:683–6.CrossRefPubMed Lanza GA, Stazi F, Colonna G, Pedrotti P, Manzoli A, Crea F, et al. Circadian variation of ischemic threshold in syndrome X. Am J Cardiol. 1995;75:683–6.CrossRefPubMed
14.
Zurück zum Zitat Lanza GA, Manzoli A, Bia E, Crea F, Maseri A. Acute effects of nitrates on exercise testing in patients with syndrome X. Clinical and pathophysiological implications. Circulation. 1994;90:2695–7009.CrossRefPubMed Lanza GA, Manzoli A, Bia E, Crea F, Maseri A. Acute effects of nitrates on exercise testing in patients with syndrome X. Clinical and pathophysiological implications. Circulation. 1994;90:2695–7009.CrossRefPubMed
15.
Zurück zum Zitat Radice M, Giudici V, Pusineri E, et al. Different effects of acute administration of aminophylline and nitroglycerin on exercise capacity in patients with syndrome X. Am J Cardiol. 1996;78:88–90. TC.CrossRefPubMed Radice M, Giudici V, Pusineri E, et al. Different effects of acute administration of aminophylline and nitroglycerin on exercise capacity in patients with syndrome X. Am J Cardiol. 1996;78:88–90. TC.CrossRefPubMed
16.•
Zurück zum Zitat Russo G, Di Franco A, Lamendola P, Tarzia P, Nerla R, Stazi A, et al. Lack of effect of nitrates on exercise stress test results in patients with microvascular angina. Cardiovasc Drugs Ther. 2013;27:229–34. A study that shows the different effects of preventive nitrates on exercise stress test in patients with chronic stable angina and microvascular angina.CrossRefPubMed Russo G, Di Franco A, Lamendola P, Tarzia P, Nerla R, Stazi A, et al. Lack of effect of nitrates on exercise stress test results in patients with microvascular angina. Cardiovasc Drugs Ther. 2013;27:229–34. A study that shows the different effects of preventive nitrates on exercise stress test in patients with chronic stable angina and microvascular angina.CrossRefPubMed
17.
Zurück zum Zitat Kaul S, Newell JB, Chesler DA, Pohost GM, Okada RD, Boucher CA. Quantitative thallium imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects. Am J Cardiol. 1986;57:509–12.CrossRefPubMed Kaul S, Newell JB, Chesler DA, Pohost GM, Okada RD, Boucher CA. Quantitative thallium imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects. Am J Cardiol. 1986;57:509–12.CrossRefPubMed
18.
Zurück zum Zitat Cavusoglu Y, Entok E, Timuralp B, Vardareli E, Kudaiberdieva G, Birdane A, et al. Regional distribution and extent of perfusion abnormalities, and the lung to heart uptake ratios during exercise thallium-201 SPECT imaging in patients with cardiac syndrome X. Can J Cardiol. 2005;21:57–62.PubMed Cavusoglu Y, Entok E, Timuralp B, Vardareli E, Kudaiberdieva G, Birdane A, et al. Regional distribution and extent of perfusion abnormalities, and the lung to heart uptake ratios during exercise thallium-201 SPECT imaging in patients with cardiac syndrome X. Can J Cardiol. 2005;21:57–62.PubMed
19.
Zurück zum Zitat Diamond JA, Makaryus AN, Sandler DA, Machac J, Henzlova MJ. Normal or near normal myocardial perfusion stress imaging in patients with severe coronary artery disease. J Cardiovasc Med (Hagerstown). 2008;9:820–5.CrossRef Diamond JA, Makaryus AN, Sandler DA, Machac J, Henzlova MJ. Normal or near normal myocardial perfusion stress imaging in patients with severe coronary artery disease. J Cardiovasc Med (Hagerstown). 2008;9:820–5.CrossRef
20.
Zurück zum Zitat Picano E, Lattanzi F, Masini M, Distante A, L’Abbate A. Usefulness of a high-dose dipyridamole-echocardiography test for diagnosis of syndrome X. Am J Cardiol. 1987;60:508–12.CrossRefPubMed Picano E, Lattanzi F, Masini M, Distante A, L’Abbate A. Usefulness of a high-dose dipyridamole-echocardiography test for diagnosis of syndrome X. Am J Cardiol. 1987;60:508–12.CrossRefPubMed
21.
Zurück zum Zitat Nihoyannopoulos P, Kaski JC, Crake T, Maseri A. Absence of myocardial dysfunction during stress in patients with syndrome X. J Am Coll Cardiol. 1991;18:1463–70.CrossRefPubMed Nihoyannopoulos P, Kaski JC, Crake T, Maseri A. Absence of myocardial dysfunction during stress in patients with syndrome X. J Am Coll Cardiol. 1991;18:1463–70.CrossRefPubMed
22.
Zurück zum Zitat Panza JA, Laurienzo JM, Curiel RV, Unger EF, Quyyumi AA, Dilsizian V, et al. Investigation of the mechanism of chest pain in patients with angiographically normal coronary arteries using transesophageal dobutamine stress echocardiography. J Am Coll Cardiol. 1997;29:293–301.CrossRefPubMed Panza JA, Laurienzo JM, Curiel RV, Unger EF, Quyyumi AA, Dilsizian V, et al. Investigation of the mechanism of chest pain in patients with angiographically normal coronary arteries using transesophageal dobutamine stress echocardiography. J Am Coll Cardiol. 1997;29:293–301.CrossRefPubMed
23.
Zurück zum Zitat Maseri A, Crea F, Kaski JC, Crake T. Mechanisms of angina pectoris in syndrome X. J Am Coll Cardiol. 1991;17:499–506.CrossRefPubMed Maseri A, Crea F, Kaski JC, Crake T. Mechanisms of angina pectoris in syndrome X. J Am Coll Cardiol. 1991;17:499–506.CrossRefPubMed
24.
Zurück zum Zitat Elhendy A, Geleijnse ML, Roelandt JR, van Domburg RT, TenCate FJ, Cornel JH, et al. Dobutamine-induced hypoperfusion without transient wall motion abnormalities: less severe ischemia or less severe stress? J Am Coll Cardiol. 1996;27:323–9.CrossRefPubMed Elhendy A, Geleijnse ML, Roelandt JR, van Domburg RT, TenCate FJ, Cornel JH, et al. Dobutamine-induced hypoperfusion without transient wall motion abnormalities: less severe ischemia or less severe stress? J Am Coll Cardiol. 1996;27:323–9.CrossRefPubMed
25.
Zurück zum Zitat Fragasso G, Chierchia SL, Lu C, Dabrowski P, Pagnotta P, Rosano GM. Left ventricular dysfunction during dobutamine stress echocardiography in patients with syndrome X and positive myocardial perfusion scintigraphy. G Ital Cardiol. 1999;29:383–90.PubMed Fragasso G, Chierchia SL, Lu C, Dabrowski P, Pagnotta P, Rosano GM. Left ventricular dysfunction during dobutamine stress echocardiography in patients with syndrome X and positive myocardial perfusion scintigraphy. G Ital Cardiol. 1999;29:383–90.PubMed
26.
Zurück zum Zitat Cadeddu C, Nocco S, Deidda M, Pau F, Colonna P, Mercuro G. Altered transmural contractility in postmenopausal women affected by cardiac syndrome X. J Am Soc Echocardiogr. 2014;27:208–14.CrossRefPubMed Cadeddu C, Nocco S, Deidda M, Pau F, Colonna P, Mercuro G. Altered transmural contractility in postmenopausal women affected by cardiac syndrome X. J Am Soc Echocardiogr. 2014;27:208–14.CrossRefPubMed
27.
Zurück zum Zitat Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.CrossRefPubMed Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008;359:2324–36.CrossRefPubMed
28.
Zurück zum Zitat Joye JD, Schulman DS. Clinical application of coronary flow reserve using an intracoronary Doppler guide wire. Cardiol Clin. 1997;15:101–29.CrossRefPubMed Joye JD, Schulman DS. Clinical application of coronary flow reserve using an intracoronary Doppler guide wire. Cardiol Clin. 1997;15:101–29.CrossRefPubMed
29.
Zurück zum Zitat Pijls NH, De Bruyne B, Smith L, Aarnoudse W, Barbato E, Bartunek J, et al. Coronary thermodilution to assess flow reserve: validation in humans. Circulation. 2002;105:2482–6.CrossRefPubMed Pijls NH, De Bruyne B, Smith L, Aarnoudse W, Barbato E, Bartunek J, et al. Coronary thermodilution to assess flow reserve: validation in humans. Circulation. 2002;105:2482–6.CrossRefPubMed
30.
Zurück zum Zitat Jerosch-Herold M, Seethamraju RT, Swingen CM, Wilke NM, Stillman AE. Analysis of myocardial perfusion MRI. J Magn Reson Imaging. 2004;19:758–70.CrossRefPubMed Jerosch-Herold M, Seethamraju RT, Swingen CM, Wilke NM, Stillman AE. Analysis of myocardial perfusion MRI. J Magn Reson Imaging. 2004;19:758–70.CrossRefPubMed
31.
Zurück zum Zitat Kaufmann PA, Camici PG. Myocardial blood flow by PET: technical aspects and clinical applications. J Nucl Med. 2005;46:75–88.PubMed Kaufmann PA, Camici PG. Myocardial blood flow by PET: technical aspects and clinical applications. J Nucl Med. 2005;46:75–88.PubMed
32.
Zurück zum Zitat Bøttcher M, Botker HE, Sonne H, Nielsen TT, Czernin J. Endothelium-dependent and -independent perfusion reserve and the effect of L-arginine on myocardial perfusion in patients with syndrome X. Circulation. 1999;99:1795–801.CrossRefPubMed Bøttcher M, Botker HE, Sonne H, Nielsen TT, Czernin J. Endothelium-dependent and -independent perfusion reserve and the effect of L-arginine on myocardial perfusion in patients with syndrome X. Circulation. 1999;99:1795–801.CrossRefPubMed
33.
Zurück zum Zitat de Vries J, DeJongste MJ, Jessurun GA, Jager PL, Staal MJ, Slart RH. Myocardial perfusion quantification in patients suspected of cardiac syndrome X with positive and negative exercise testing: a [13N] ammonia positron emission tomography study. Nucl Med Commun. 2006;27:791–4.CrossRefPubMed de Vries J, DeJongste MJ, Jessurun GA, Jager PL, Staal MJ, Slart RH. Myocardial perfusion quantification in patients suspected of cardiac syndrome X with positive and negative exercise testing: a [13N] ammonia positron emission tomography study. Nucl Med Commun. 2006;27:791–4.CrossRefPubMed
34.
Zurück zum Zitat Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P, et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med. 2002;346:1948–53.CrossRefPubMed Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P, et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med. 2002;346:1948–53.CrossRefPubMed
35.
Zurück zum Zitat Lanza GA, Buffon A, Sestito A, Natale L, Sgueglia GA, Galiuto L, et al. Relation between stress-induced myocardial perfusion defects on cardiovascular magnetic resonance and coronary microvascular dysfunction in patients with cardiac syndrome X. J Am Coll Cardiol. 2008;51:466–72.CrossRefPubMed Lanza GA, Buffon A, Sestito A, Natale L, Sgueglia GA, Galiuto L, et al. Relation between stress-induced myocardial perfusion defects on cardiovascular magnetic resonance and coronary microvascular dysfunction in patients with cardiac syndrome X. J Am Coll Cardiol. 2008;51:466–72.CrossRefPubMed
36.
Zurück zum Zitat Grayburn PA. “Product safety” compromises patient safety (an unjustified black box warning on ultrasound contrast agents by the Food and Drug Administration). Am J Cardiol. 2008;101:892–3.CrossRefPubMed Grayburn PA. “Product safety” compromises patient safety (an unjustified black box warning on ultrasound contrast agents by the Food and Drug Administration). Am J Cardiol. 2008;101:892–3.CrossRefPubMed
37.
Zurück zum Zitat Meimoun P, Tribouilloy C. Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: a magic tool for the real world. Eur J Echocardiogr. 2008;9:449–57.CrossRefPubMed Meimoun P, Tribouilloy C. Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: a magic tool for the real world. Eur J Echocardiogr. 2008;9:449–57.CrossRefPubMed
38.
Zurück zum Zitat Hozumi T, Yoshida K, Akasaka T, Asami Y, Ogata Y, Takagi T, et al. Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: comparison with invasive technique. J Am Coll Cardiol. 1998;32:1251–9.CrossRefPubMed Hozumi T, Yoshida K, Akasaka T, Asami Y, Ogata Y, Takagi T, et al. Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: comparison with invasive technique. J Am Coll Cardiol. 1998;32:1251–9.CrossRefPubMed
39.
Zurück zum Zitat Saraste M, Koskenvuo J, Knuuti J, Toikka J, Laine H, Niemi P, et al. Coronary flow reserve: measurement with transthoracic Doppler echocardiography is reproducible and comparable with positron emission tomography. Clin Physiol. 2001;21:114–22.CrossRefPubMed Saraste M, Koskenvuo J, Knuuti J, Toikka J, Laine H, Niemi P, et al. Coronary flow reserve: measurement with transthoracic Doppler echocardiography is reproducible and comparable with positron emission tomography. Clin Physiol. 2001;21:114–22.CrossRefPubMed
40.
Zurück zum Zitat Galiuto L, Sestito A, Barchetta S, Sgueglia GA, Infusino F, La Rosa C, et al. Noninvasive evaluation of flow reserve in the left anterior descending coronary artery in patients with cardiac syndrome X. Am J Cardiol. 2007;99:1378–83.CrossRefPubMed Galiuto L, Sestito A, Barchetta S, Sgueglia GA, Infusino F, La Rosa C, et al. Noninvasive evaluation of flow reserve in the left anterior descending coronary artery in patients with cardiac syndrome X. Am J Cardiol. 2007;99:1378–83.CrossRefPubMed
41.
Zurück zum Zitat Berne RM. The role of adenosine in the regulation of coronary blood flow. Circ Res. 1980;47:807–13.CrossRefPubMed Berne RM. The role of adenosine in the regulation of coronary blood flow. Circ Res. 1980;47:807–13.CrossRefPubMed
42.
Zurück zum Zitat Wang T, Mentzer Jr RM, Van Wylen DG. Interstitial adenosine with dipyridamole: effect of adenosine receptor blockade and adenosine deaminase. Am J Physiol. 1992;263(2 Pt 2):H552–8.PubMed Wang T, Mentzer Jr RM, Van Wylen DG. Interstitial adenosine with dipyridamole: effect of adenosine receptor blockade and adenosine deaminase. Am J Physiol. 1992;263(2 Pt 2):H552–8.PubMed
43.
Zurück zum Zitat Prior JO, Schindler TH, Facta AD, Hernandez-Pampaloni M, Campisi R, Dahlbom M, et al. Determinants of myocardial blood flow response to cold pressor testing and pharmacologic vasodilation in healthy humans. Eur J Nucl Med Mol Imaging. 2007;34:20–7.CrossRefPubMed Prior JO, Schindler TH, Facta AD, Hernandez-Pampaloni M, Campisi R, Dahlbom M, et al. Determinants of myocardial blood flow response to cold pressor testing and pharmacologic vasodilation in healthy humans. Eur J Nucl Med Mol Imaging. 2007;34:20–7.CrossRefPubMed
44.
Zurück zum Zitat Buchthal SD, den Hollander JA, Merz CN, Rogers WJ, Pepine CJ, Reichek N, et al. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms. N Engl J Med. 2000;342:829–35.CrossRefPubMed Buchthal SD, den Hollander JA, Merz CN, Rogers WJ, Pepine CJ, Reichek N, et al. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms. N Engl J Med. 2000;342:829–35.CrossRefPubMed
45.••
Zurück zum Zitat Sestito A, Lanza GA, Di Monaco A, Lamendola P, Careri G, Tarzia P, et al. Relation between cardiovascular risk factors and coronary microvascular dysfunction in cardiac syndrome X. J Cardiovasc Med (Hagerstown). 2011;12:322–7. A study that shows the variable endothelium-dependent and endothelium-independent coronary microvascular impairment in patients with exercise induced angina and normal coronary arteries.CrossRef Sestito A, Lanza GA, Di Monaco A, Lamendola P, Careri G, Tarzia P, et al. Relation between cardiovascular risk factors and coronary microvascular dysfunction in cardiac syndrome X. J Cardiovasc Med (Hagerstown). 2011;12:322–7. A study that shows the variable endothelium-dependent and endothelium-independent coronary microvascular impairment in patients with exercise induced angina and normal coronary arteries.CrossRef
46.
Zurück zum Zitat Quyyumi AA, Dakak N, Mulcahy D, Andrews NP, Husain S, Panza JA, et al. Nitric oxide activity in the atherosclerotic human coronary circulation. J Am Coll Cardiol. 1997;29:308–17.CrossRefPubMed Quyyumi AA, Dakak N, Mulcahy D, Andrews NP, Husain S, Panza JA, et al. Nitric oxide activity in the atherosclerotic human coronary circulation. J Am Coll Cardiol. 1997;29:308–17.CrossRefPubMed
48.
Zurück zum Zitat Cannon 3rd RO, Watson RM, Rosing DR, Epstein SE. Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol. 1983;1:1359–73.CrossRefPubMed Cannon 3rd RO, Watson RM, Rosing DR, Epstein SE. Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol. 1983;1:1359–73.CrossRefPubMed
49.
Zurück zum Zitat Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126:e354–471.CrossRefPubMed Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126:e354–471.CrossRefPubMed
50.
Zurück zum Zitat Fragasso G, Lauretta L, Busnardo E, Cera M, Godino C, Colombo A, et al. Prognostic role of stress/rest myocardial perfusion scintigraphy in patients with cardiac syndrome X. Int J Cardiol. 2014;173:467–71.CrossRefPubMed Fragasso G, Lauretta L, Busnardo E, Cera M, Godino C, Colombo A, et al. Prognostic role of stress/rest myocardial perfusion scintigraphy in patients with cardiac syndrome X. Int J Cardiol. 2014;173:467–71.CrossRefPubMed
51.
Zurück zum Zitat Alqaisi F, AlBadarin F, Jaffery Z, Tzogias L, Dawod M, Jacobsen G, et al. Prognostic predictors and outcomes in patients with abnormal myocardial perfusion imaging and angiographically insignificant coronary artery disease. J Nucl Cardiol. 2008;15:754–61.CrossRefPubMed Alqaisi F, AlBadarin F, Jaffery Z, Tzogias L, Dawod M, Jacobsen G, et al. Prognostic predictors and outcomes in patients with abnormal myocardial perfusion imaging and angiographically insignificant coronary artery disease. J Nucl Cardiol. 2008;15:754–61.CrossRefPubMed
52.
Zurück zum Zitat Sicari R, Palinkas A, Pasanisi EG, Venneri L, Picano E. Long-term survival of patients with chest pain syndrome and angiographically normal or near-normal coronary arteries: the additional prognostic value of dipyridamole echocardiography test (DET). Eur Heart J. 2005;26:2136–41.CrossRefPubMed Sicari R, Palinkas A, Pasanisi EG, Venneri L, Picano E. Long-term survival of patients with chest pain syndrome and angiographically normal or near-normal coronary arteries: the additional prognostic value of dipyridamole echocardiography test (DET). Eur Heart J. 2005;26:2136–41.CrossRefPubMed
53.
Zurück zum Zitat Britten MB, Zeiher AM, Schachinger V. Microvascular dysfunction in angiographically normal or mildly diseased coronary arteries predicts adverse cardiovascular long-term outcome. Coron Artery Dis. 2004;15:259–64.CrossRefPubMed Britten MB, Zeiher AM, Schachinger V. Microvascular dysfunction in angiographically normal or mildly diseased coronary arteries predicts adverse cardiovascular long-term outcome. Coron Artery Dis. 2004;15:259–64.CrossRefPubMed
54.
Zurück zum Zitat Pepine CJ, Anderson RD, Sharaf BL, Reis SE, Smith KM, Handberg EM, et al. Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women’s Ischemia Syndrome Evaluation) study. J Am Coll Cardiol. 2010;55:2825–32.PubMedCentralCrossRefPubMed Pepine CJ, Anderson RD, Sharaf BL, Reis SE, Smith KM, Handberg EM, et al. Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women’s Ischemia Syndrome Evaluation) study. J Am Coll Cardiol. 2010;55:2825–32.PubMedCentralCrossRefPubMed
55.
Zurück zum Zitat Lamendola P, Lanza GA, Spinelli A, Sgueglia GA, Di Monaco A, Barone L, et al. Long-term prognosis of patients with cardiac syndrome X. Int J Cardiol. 2010;140:197–9.CrossRefPubMed Lamendola P, Lanza GA, Spinelli A, Sgueglia GA, Di Monaco A, Barone L, et al. Long-term prognosis of patients with cardiac syndrome X. Int J Cardiol. 2010;140:197–9.CrossRefPubMed
56.
Zurück zum Zitat Kaski JC, Rosano GMC, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol. 1995;25:807–14.CrossRefPubMed Kaski JC, Rosano GMC, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol. 1995;25:807–14.CrossRefPubMed
57.
Zurück zum Zitat Lanza GA, Andreotti F, Sestito A, Sciahbasi A, Crea F, Maseri A. Platelet aggregability in cardiac syndrome X. Eur Heart J. 2001;22:1924–30.CrossRefPubMed Lanza GA, Andreotti F, Sestito A, Sciahbasi A, Crea F, Maseri A. Platelet aggregability in cardiac syndrome X. Eur Heart J. 2001;22:1924–30.CrossRefPubMed
58.
Zurück zum Zitat Gulati M, Cooper-DeHoff RM, McClure C, Johnson BD, Shaw LJ, Handberg EM, et al. Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women’s Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med. 2009;169:843–50.PubMedCentralCrossRefPubMed Gulati M, Cooper-DeHoff RM, McClure C, Johnson BD, Shaw LJ, Handberg EM, et al. Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women’s Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med. 2009;169:843–50.PubMedCentralCrossRefPubMed
59.
Zurück zum Zitat Jespersen L, Hvelplund A, Abildstrøm SZ, Pedersen F, Galatius S, Madsen JK, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33:734–44.CrossRefPubMed Jespersen L, Hvelplund A, Abildstrøm SZ, Pedersen F, Galatius S, Madsen JK, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J. 2012;33:734–44.CrossRefPubMed
60.
Zurück zum Zitat Sgueglia GA, Sestito A, Spinelli A, Cioni B, Infusino F, Papacci F, et al. Long-term follow-up of cardiac syndrome X patients treated by spinal cord stimulation. Heart. 2007;93:591–7.PubMedCentralCrossRefPubMed Sgueglia GA, Sestito A, Spinelli A, Cioni B, Infusino F, Papacci F, et al. Long-term follow-up of cardiac syndrome X patients treated by spinal cord stimulation. Heart. 2007;93:591–7.PubMedCentralCrossRefPubMed
61.
Zurück zum Zitat Cannon RO, Quyyumi AA, Schenke WH, et al. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol. 1990;16:1359–66.CrossRefPubMed Cannon RO, Quyyumi AA, Schenke WH, et al. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol. 1990;16:1359–66.CrossRefPubMed
62.
Zurück zum Zitat Pasceri V, Lanza GA, Buffon A, Montenero AS, Crea F, Maseri A. Role of abnormal pain sensitivity and behavioral factors in determining chest pain in syndrome X. J Am Coll Cardiol. 1998;31:62–6.CrossRefPubMed Pasceri V, Lanza GA, Buffon A, Montenero AS, Crea F, Maseri A. Role of abnormal pain sensitivity and behavioral factors in determining chest pain in syndrome X. J Am Coll Cardiol. 1998;31:62–6.CrossRefPubMed
63.
Zurück zum Zitat Benjamin SB. Microvascular angina and the sensitive heart: historical perspective. Am J Med. 1992;92:52S–6S.CrossRefPubMed Benjamin SB. Microvascular angina and the sensitive heart: historical perspective. Am J Med. 1992;92:52S–6S.CrossRefPubMed
64.
Zurück zum Zitat Di Monaco A, Lanza GA, Bruno I, Careri G, Pinnacchio G, Tarzia P, et al. Usefulness of impairment of cardiac adrenergic nerve function to predict outcome in patients with cardiac syndrome X. Am J Cardiol. 2010;106:1813–8.CrossRefPubMed Di Monaco A, Lanza GA, Bruno I, Careri G, Pinnacchio G, Tarzia P, et al. Usefulness of impairment of cardiac adrenergic nerve function to predict outcome in patients with cardiac syndrome X. Am J Cardiol. 2010;106:1813–8.CrossRefPubMed
65.
Zurück zum Zitat Di Franco A, Villano A, Di Monaco A, Lamendola P, Russo G, Stazi A, et al. Correlation between coronary microvascular function and angina status in patients with stable microvascular angina. Eur Rev Med Pharmacol Sci. 2014;18:374–9.PubMed Di Franco A, Villano A, Di Monaco A, Lamendola P, Russo G, Stazi A, et al. Correlation between coronary microvascular function and angina status in patients with stable microvascular angina. Eur Rev Med Pharmacol Sci. 2014;18:374–9.PubMed
66.
Zurück zum Zitat Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global use of strategies to open occluded coronary arteries in acute coronary syndromes IIb investigators. N Engl J Med. 1999;341:226–32.CrossRefPubMed Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global use of strategies to open occluded coronary arteries in acute coronary syndromes IIb investigators. N Engl J Med. 1999;341:226–32.CrossRefPubMed
67.
Zurück zum Zitat Patel MR, Chen AY, Peterson ED, et al. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J. 2006;152:641–7.CrossRefPubMed Patel MR, Chen AY, Peterson ED, et al. Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) initiative. Am Heart J. 2006;152:641–7.CrossRefPubMed
68.
Zurück zum Zitat Lanza GA, Crea F. Acute coronary syndromes without obstructive coronary atherosclerosis: the tiles of a complex puzzle. Circ Cardiovasc Interv. 2014;7:278–81.CrossRefPubMed Lanza GA, Crea F. Acute coronary syndromes without obstructive coronary atherosclerosis: the tiles of a complex puzzle. Circ Cardiovasc Interv. 2014;7:278–81.CrossRefPubMed
69.
Zurück zum Zitat Beltrame JF, Limaye SB, Wuttke RD, Horowitz JD. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J. 2003;146:84–90.CrossRefPubMed Beltrame JF, Limaye SB, Wuttke RD, Horowitz JD. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J. 2003;146:84–90.CrossRefPubMed
70.
Zurück zum Zitat Beltrame JF, Turner SP, Leslie SL, Solomon P, Freedman SB, Horowitz JD. The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon. J Am Coll Cardiol. 2004;44:57–62.CrossRefPubMed Beltrame JF, Turner SP, Leslie SL, Solomon P, Freedman SB, Horowitz JD. The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon. J Am Coll Cardiol. 2004;44:57–62.CrossRefPubMed
71.
Zurück zum Zitat Ohba K, Sugiyama S, Sumida H, Nozaki T, Matsubara J, Matsuzawa Y, et al. Microvascular coronary artery spasm presents distinctive clinical features with endothelial dysfunction as nonobstructive coronary artery disease. J Am Heart Assoc. 2012;1:e002485.PubMedCentralCrossRefPubMed Ohba K, Sugiyama S, Sumida H, Nozaki T, Matsubara J, Matsuzawa Y, et al. Microvascular coronary artery spasm presents distinctive clinical features with endothelial dysfunction as nonobstructive coronary artery disease. J Am Heart Assoc. 2012;1:e002485.PubMedCentralCrossRefPubMed
72.
Zurück zum Zitat Galiuto L, De Caterina AR, Porfidia A, Paraggio L, Barchetta S, Locorotondo G, et al. Reversible coronary microvascular dysfunction: a common pathogenetic mechanism in apical ballooning or tako-tsubo syndrome. Eur Heart J. 2010;31:1319–27.CrossRefPubMed Galiuto L, De Caterina AR, Porfidia A, Paraggio L, Barchetta S, Locorotondo G, et al. Reversible coronary microvascular dysfunction: a common pathogenetic mechanism in apical ballooning or tako-tsubo syndrome. Eur Heart J. 2010;31:1319–27.CrossRefPubMed
73.
Zurück zum Zitat Mohri M, Koyanagi M, Egashira K, Tagawa H, Ichiki T, Shimokawa H, et al. Angina pectoris caused by coronary microvascular spasm. Lancet. 1998;351:1165–9.CrossRefPubMed Mohri M, Koyanagi M, Egashira K, Tagawa H, Ichiki T, Shimokawa H, et al. Angina pectoris caused by coronary microvascular spasm. Lancet. 1998;351:1165–9.CrossRefPubMed
74.
Zurück zum Zitat Dokainish H, Pillai M, Murphy SA, DiBattiste PM, Schweiger MJ, Lotfi A, et al. Prognostic implications of elevated troponin in patients with suspected acute coronary syndrome but no critical epicardial coronary disease: a TACTICS-TIMI-18 substudy. J Am Coll Cardiol. 2005;45:19–24.CrossRefPubMed Dokainish H, Pillai M, Murphy SA, DiBattiste PM, Schweiger MJ, Lotfi A, et al. Prognostic implications of elevated troponin in patients with suspected acute coronary syndrome but no critical epicardial coronary disease: a TACTICS-TIMI-18 substudy. J Am Coll Cardiol. 2005;45:19–24.CrossRefPubMed
75.
Zurück zum Zitat Planer D, Mehran R, Ohman EM, White HD, Newman JD, Xu K, et al. Prognosis of patients with non-ST-segment elevation myocardial infarction and non-obstructive coronary artery disease: propensity matched analysis from the ACUITY trial. Circulation Cardiovasc Interv. 2014;7:285–93.CrossRef Planer D, Mehran R, Ohman EM, White HD, Newman JD, Xu K, et al. Prognosis of patients with non-ST-segment elevation myocardial infarction and non-obstructive coronary artery disease: propensity matched analysis from the ACUITY trial. Circulation Cardiovasc Interv. 2014;7:285–93.CrossRef
Metadaten
Titel
Angina Pectoris and Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease: Role of Diagnostic Tests
verfasst von
Gaetano Antonio Lanza
Publikationsdatum
01.02.2016
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 2/2016
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-015-0688-3

Weitere Artikel der Ausgabe 2/2016

Current Cardiology Reports 2/2016 Zur Ausgabe

Interventional Cardiology (S Rao, Section Editor)

Interventional Options for Coronary Artery Calcification

Nuclear Cardiology (V Dilsizian, Section Editor)

Nuclear Imaging Guidance for Ablation of Ventricular Arrhythmias

Cardiac PET, CT, and MRI (SE Petersen and F Pugliese, Section Editors)

Role of Cardiac CT Before Transcatheter Aortic Valve Implantation (TAVI)

Cardiac PET, CT, and MRI (SE Petersen and F Pugliese, Section Editors)

Coronary CT Angiography as a Diagnostic and Prognostic Tool: Perspectives from the SCOT-HEART Trial

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.