Medição do Fluxo Sanguíneo Coronário em Angiogramas Coronários Convencionais por um Novo Método Baseado na Detecção da Densidade de Contraste. Uma Visão Fisiológica / Coronary Blood Flow Measurement in Conventional Coronary Angiograms by a New Method Based on Contrast Density Detection. A Physiological Insight

Resumo Fundamento O grau de fluxo TIMI e a contagem quadro a quadro TIMI corrigida (CTFC) são métodos amplamente utilizados para avaliar o fluxo sanguíneo coronariano angiográfico. A medição do fluxo sanguíneo coronariano (FSC) na coronariografia (CAG) padrão despertou grande interesse recentemente, tentando combinar o conceito de CTFC com novos métodos para pós-angioplastia e avaliação da síndrome cardíaca X. Além disso, o fluxo coronariano lento é considerado um critério importante para a angina microvascular. Objetivo Explorar uma nova abordagem de medição angiográfica quantitativa do FSC com base na detecção densitométrica de contraste na CAG offline, usando um software acessível para obter uma avaliação mais precisa e confiável do FSC. Métodos Trinta pacientes foram estudados e divididos em 2 grupos: fluxo sanguíneo coronariano normal (FN) e fluxo sanguíneo coronariano lento (FL), de acordo com a definição da CTFC. O MD foi aplicado à amostra do estudo para diferenciar entre FN e FL. A estatística não paramétrica foi usada para avaliar diferenças entre os grupos com p<0,05. Resultados O valor de referência normal do MD obtido para o fluxo sanguíneo coronariano foi de 9 [5-10] quadros. Os grupos FN vs. FL foi comparado e expresso como mediana [intervalo interquartil], para a artéria descendente anterior esquerda: 10 [7-11] vs. 21 [8-33]; p=0,016; artéria circunflexa: 9 [4-13] vs. 14 [11-30]; p=0,012 e artéria coronária direita: 5 [3-11] vs. 13 [8-26]; p=0,009. Conclusão O MD mostrou a viabilidade de medir o fluxo sanguíneo coronariano com precisão, consistência e reprodutibilidade em um angiograma coronariano padrão, mostrando a capacidade adicional de diferenciar FN de FL em pacientes com dor precordial e artérias coronárias normais. (Arq Bras Cardiol. 2020; 115(3):503-512)

Abstract Background TIMI flow grade and corrected TIMI frame count (CTFC) are widely used methods to evaluate angiographic coronary blood flow. Measurement of coronary blood flow (CBF) on standard coronary angiography (CAG) has aroused great interest recently, trying to combine the CTFC concept with new methods for post-angioplasty and for cardiac syndrome X assessment. Additionally, coronary slow flow it is now considered a major criterion for microvascular angina. Objective Explore a new approach of quantitative angiographic measurement of CBF based on densitometric contrast detection in CAG off-line, using an accessible software to obtain a more precise and reliable CBF assessment. Methods Thirty patients were studied and divided in 2 groups, normal coronary blood flow (NF) and slow coronary blood flow (SF), according to CTFC definition. The DM was applied to the study sample to differentiate between NF and SF. Non-parametric statistics was used to assess differences between groups at p<0.05. Results The DM normal reference value obtained for coronary blood flow was 9 [5-10] frames. NF vs SF group were compared and expressed as median [interquartile range], for the left anterior descending: 10 [7-11] vs 21 [8-33];p= 0.016; circumflex: 9 [4-13] vs 14 [11-30]; p= 0.012 and right coronary artery: 5 [3-11] vs 13 [8-26]; p=0.009. Conclusion The DM showed the feasibility of measuring coronary blood flow with precision, consistency and reproducible in a standard coronary angiogram, showing the additional capability to differentiate between NF and SF in chest pain patients with normal coronary arteries. (Arq Bras Cardiol. 2020; 115(3):503-512)

Correlation between heart rate variability and exercise ability in patients with cardiac syndrome X / 中国实用内科杂志

OBJECTIVE: To investigate whether heart rate variability(HRV) can assess exercise ability in patients with cardiac syndrome X(CSX). METHODS: A total of 246 subjects(55.2 ± 12.2 years, 68.3% male), who were diagnosed with CSX by the positive exercise stress test and normal coronary angiogram in Cardiovascular Department of the Second Affiliated Hospital of Harbin Medical University from March 2016 to August 2017 were enrolled. The 24-hour dynamic ECG monitoring was used to analyze HRV for long-time frequency domain analysis. The HRV power spectrum index included total power(TP),very low frequency(VLF), low frequency(LF) and high frequency(HF). RESULTS: VLF, LF and TP, but not LF/HF, were higher in the patients with good exercise capacity(≥90% of the age predicted maximal heart rate). After accounting for age, sex, systolic blood pressure and heart rate, VLF, LF and TP remained significantly associated with good exercise capacity. In addition, increased VLF, LF and TP were also associated with increased exercise duration, rate-pressure product, and heart rate recovery. In subgroup analysis, VLF, LF and TP demonstrated similar predictive values related to exercise capacity across various subpopulations, especially in the young. CONCLUSION: In patients with CSX, HRV is independently associated with exercise capacity, and is an independent predictor of ischemic tolerance in CSX patients, which can be used as an important index for evaluating the exercise ability of CSX patients.

Tongxinluo Capsule () for Cardiac Syndrome X: A Systematic Review and Meta-Analysis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of Tongxinluo Capsule (, TXL) for patients with cardiac syndrome X (CSX).</p><p><b>METHODS</b>Randomized controlled trials (RCTs) regarding TXL in the treatment of CSX were searched in Chinese Biomedicine Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, PubMed, EMBASE, Cochrane Central Register of Controlled Trial, websites of the Chinese and International Clinical Trial Registry platform up to June 30, 2015. The intervention was either TXL alone or TXL combined with conventional treatment, while the control intervention was conventional treatment with or without placebo. Data extraction, methodological quality assessment and data analyses were performed according to the Cochrane criteria. The primary outcome was a composite event of death, acute myocardial infarction (AMI), angina requiring hospitalization, revascularization, and heart failure. The secondary outcome measures were angina symptom improvement, electrocardiograph (ECG) improvement, and serum endothelin-1 (ET-1) level. The adverse events were also recorded. RevMan 5.3 software was applied for data analyses.</p><p><b>RESULTS</b>Twelve RCTs (696 patients) were included. Compared with conventional treatment, the addition of TXL to conventional treatment showed some benefits on relieving angina symptoms [risk ratio (RR): 1.46, 95% confidence interval (CI) (1.25, 1.71), P<0.01], and improving ECG [RR: 1.45, 95% CI (1.21, 1.74), P<0.01]. The pooled result did not support a benefit of TXL on reducing the incidence of primary outcome [RR: 0.20, 95% CI (0.02, 1.61), P=0.13]. In addition, TXL decreased serum ET-1 concentration of CSX patients [standardized mean number:-1.63, 95% CI (-2.29,-0.96), P<0.01]. No serious adverse events were reported.</p><p><b>CONCLUSIONS</b>TXL documents potential benefits on attenuating angina symptoms, improving ECG and decreasing serum ET-1 level for CSX patients. However, more rigorous RCTs with high quality are needed to confirm its efficacy and safety.</p>

Effect of Warm Needling plus Atorvastatin on Cardiac Syndrome X in Women / 上海针灸杂志

Objective To discuss the application value of the treatment protocol of combining warm needling and atorvastatin in treating female cardiac syndrome X (CSX). Method Eighty female CSX patients were randomized into a control group and an observation group by the random number table, 40 cases in each group. The control group was intervened by atorvastatin in addition to the conventional treatment protocol, while the observation group was by warm needling plus atorvastatin in addition to the conventional treatment. The treatment efficacies and adverse events rates were compared between the two groups. Result There were no significant between-group differences in comparing the component and total scores of the Cardiac Anxiety Questionnaire (CAQ), NO, plasma endothelin (ET-1) and hypersensitive C-reactive protein (hs-CRP) levels before the intervention (P>0.05);after 8-week treatment, the component and total scores of CAQ, ET-1, and hs-CRP levels were significantly lower in the observation group than in the control group, and NO level was significantly higher in the observation group than in the control group (P0.05). Conclusion In the treatment of female CSX, warm needling plus atorvastatin can enhance the treatment efficacy.

Suspected Microvascular Coronary Spasm Diagnosed by Spasm Provocation Test with High Dose of Acetylcholine.

A 71-year-old Japanese man was admitted to our hospital complaining of chest oppression on exercise, such as cycling uphill, which had continued for 9 years. We diagnosed him as having microvascular spasm according to the results of coronary angiography with an acetylcholine provocation test with a high dose (150g) of acetylcholine administrated at a time during 20 seconds. Electrocardiographic changes during the spasm provocation test resembled that during exercise tests performed upon admission and 9 years previously. He was treated with a calcium channel blocker and partial symptom relief was obtained.

Evaluation of the mean platelet volume in patients with cardiac syndrome X

OBJECTIVE: Cardiac syndrome X is characterized by angina-lke chest pain, a positive stress test, and normal coronary arteries. A patient's mean platelet volume, which potentially reflects platelet function and activity, is associated with coronary atherosclerosis and endothelial dysfunction. The aim of the present study was to evaluate the mean platelet volumes of patients with cardiac syndrome X, those with coronary artery disease and normal subjects. METHODS: Two hundred thirty-six subjects (76 patients with cardiac syndrome X, 78 patients with coronary artery disease, and 82 controls) were enrolled in the study. All of the subjects were evaluated with a detailed medical history, physical examination, and biochemical analyses. The mean platelet volumes were compared between the three groups. RESULTS: The mean platelet volumes in the patients with cardiac syndrome X and with coronary artery disease were significantly higher than those that were observed in the control group. There were no significant differences in the mean platelet volumes between the cardiac syndrome X and the coronary artery disease groups. CONCLUSION: We have established that patients with cardiac syndrome X and coronary artery disease exhibit higher mean platelet volumes compared to controls. Patients with cardiac syndrome X exhibited higher mean platelet volumes compared to the controls, reflecting the presence of subclinical atherosclerosis. These findings suggest that, in addition to endothelial dysfunction, the presence of atherosclerosis may also contribute to the etiopathogenesis of cardiac syndrome X.

Increased Arterial Stiffness in Patients with Cardiac Syndrome X: Pulse Wave Velocity in Cardiac Syndrome X

BACKGROUND AND OBJECTIVES: Up to 10% of coronary angiograms performed for the assessment of patients with chest pain show a normal coronary anatomy. Arterial dysfunction has been reported in patients with cardiac syndrome X (CSX). The Pulse Wave Velocity (PWV) has been shown to be an indicator of arterial stiffness. The aim of this study was to evaluate the atherosclerotic risk factors and arterial stiffness by measuring the pulse wave velocity in patients with CSX. SUBJECTS AND METHODS: Sixty patients, with typical chest pain and a normal coronary anatomy, were enrolled, and divided into 2 groups; the CSX group, consisting of 34 patients (male: 14, mean age 57.1+/-11.5 years) with a positive stress tests, and the control group, which contained 26 patients (male: 7, mean age: 55.4+/-10.9 years), who were diagnosed with gastro-esophageal disorders. Arterial stiffness was assessed by measuring the carotid-radial PWV. The cardiovascular risk factors, including body mass index, lipid profile, left ventricular mass, pulse pressure, plasma homocysteine and C-reactive protein, were also measured. RESULTS: The PWV was significantly higher in patients with CSX than in the controls (10.28+/-1.02 vs. 8.62+/-1.18 m/s, p<0.05). However, there was no difference in the other atherosclerotic risk factors between the groups. The cutoff value for PWV was 9.85 m/s, with sensitivity and specificity of 65 and 88%, respectively. CONCLUSION: In patients with CSX, the arterial stiffness was increased compared to the controls, but no increase the cardiovascular risk factors were observed. PWV assessment might be a helpful tool in identifying CSX patients with chest pain of a noncardiac origin.

The Effect of Atorvastatin on Seumr Hypersensitive C-reactive Protein Level in Patients with Cardiac Syndrome X / 中国医师杂志

Objective To explore the level changes of serum hypersensitive C-reactive protein (hs-CRP) in patients with cardiac syndrome X (CSX) and the effect of atorvastatin on hs-CRP level. Methods 25 patients with CSX and 10 matched healthy subjects were enrolled in this study, and the serum hs-CRP levels were compared between the patients and healthy subjects. The patients were randomly devidid into routine therapy group (n=12), which received diltiazem 30mg t.i.d and isorbide dinitrate 10mg t.i.d, and atovastatin thrapy group (n=13), which received the same dosage of diltiazem and isobide dinitrate, and atovastatin 20mg/d additionally. The course of treatment was 12 weeks. At the beginning and the end of study, standardized angina questionnaires and exercise stress test were performed in all patients, and their serum hs-CRP levels were measured. Results ⑴The serum hs-CRP levels of patients with CSX were significantly hagher than those of healthy subjects(3 7?3 2mg/L vs 0 9?0 5mg/L, P

A Comparison Study between Cardiac Syndrome X and Cardiac Neurosis / 中国医师杂志

0 05). The levels of TC, LDL-C and apoB in the patients with CSX were significantly higher than those in the patients with CN(P

Analysis on the Characteristics of TCM Syndrome in 51 Patients with Cardiac Syndrome X / 中医杂志

Objective To explore the TCM syndrome characteristics of cardiac syndrome X(CSX).Methods The signs and symptoms of 51 patients with CSX were analyzed according to the diagnosis of TCM syndromes to summarize their syndrome character- istics.Results of the 51 CSX cases,the following signs and symptoms took dominance:chest pain,fullness in chest,epigastric and abdominal distention,emotional distress,dark purple tongue with petechia,greasy coating,string-taut pulse.The syndromes were mainly of Biao-Superficial excess,including qi stagnation,phlegm retention and blood stasis,occupying 66. 7%,accompanied with Benroot deficiency,including qi deficiency,yin deficiency,qi and yin both deficiency,occupying 33.3%.Conclusion Qi stagnation, phlegm retention and blood stasis are the primary syndromes of CSX.