Lack of significant association between Helicobacter pylori infection and homocysteine levels in patients with cardiac syndrome X.

BACKGROUND: Helicobacter pylori (H.pylori) has been implicated in the pathogenesis of several diseases such as cardiac syndrome X (CSX), which includes chest pain, positive exercise stress test and normal angiography. Also, elevation of homocysteine (Hcy) level is associated with CSX, as it can severely disturb vascular endothelial function. We aimed to elucidate whether the infection of H.pylori affect the level of Hcy in CSX. METHODS: Eighty-eight patients with CSX (32 men, 56 women; mean age: 53.8 ± 11.9) and 97 healthy controls (36 men, 61 women; mean age: 45.7 ± 7.3) were enrolled. Plasma samples were tested for the presence of IgG antibody to H.pylori using enzyme linked immunosorbent assay method. Hcy levels were measured enzymatically. RESULTS: Plasma Hcy concentration in CSX patients is higher than control group (13.1 ± 2.6 vs. 11.8 ± 2.5 mmol/L; p = 0.002). There was no significant difference between Hcy in H.pylori(+) and H.pylori(-) individuals in CSX group (13.1 ± 2.7 vs. 12.2 ± 0.6 mmol/L; p = 0.554) and between two groups in controls, respectively (12.1 ± 2.2 vs. 11.4 ± 2.9 mmol/L; p = 0.148). CONCLUSIONS: Although there is Hcy level increase in H.pylori(+) CSX patients and controls comparing to H.pylori(-) subjects, but other factors may affect on Hcy level, too. (Cardiol J 2012; 19, 5: 466-469).

Association of inflammation and cytotoxin-associated gene a positive strains of helicobacter pylori in cardiac syndrome x.

BACKGROUND: Cardiac syndrome X (CSX) is a condition in which patients have the pain of angina despite normal coronary angiogram. Helicobacter pylori (H. pylori) infection causes chronic inflammation which may play a pathogenic role in CSX. We surveyed the association of inflammation with H. pylori and its virulent strain (cytotoxin-associated gene A positive; CagA+) infections with CSX. MATERIAL AND METHODS: Sixty patients with CSX (38 women/22 men; mean age: 51.8 ± 12.3) and 60 age- and gender-matched healthy controls (39 women/21 men; mean age: 48.9 ± 6.3) were enrolled. Plasma samples were tested for the presence of IgG antibody to H. pylori using enzyme linked immunosorbent assay (ELISA) method. IgG- positive patients were determined by the presence of IgG antibody to CagA, also by ELISA method. Also, plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured by ELISA method. RESULTS: Patients with CSX were detected to have significantly higher plasma IL-6 and TNF-α level in comparison with normal controls (33.6 ± 3.5 vs 3.2 ± 0.4 and 24.2 ± 2.3 vs 3.1 ± 0.4, respectively; p < 0.01). The plasma levels of these inflammatory factors in CgA+ were significantly higher than those in CagA- (CSX: IL-6: 43.05 ± 5.04 vs 23.97 ± 4.58 and TNF-α: 31.43 ± 3.13 vs 16.47 ± 2.93, CONTROLS: IL-6: 3.52 ± 1.39 vs 2.90 ± 0.67 and TNF-α: 5.39 ± 1.17 vs 2.22 ± 0.43, respectively; p < 0.05). CONCLUSION: The CagA+ strain of H. pylori, can not only be a trigger, and may also have a role via chronic inflammation in the pathogenesis of CSX.

Possible pathogenetic role of Helicobacter pylori infection in cardiac syndrome X.

The diagnosis of cardiac syndrome X (CSX) is often a diagnosis of exclusion and hence requires a systematic and comprehensive assessment of each patient to rule out more common causes of chest discomfort. The definitive technique for the diagnosis of CSX is not currently available. Many patients with chest pain and normal coronary angiograms have neither metabolic nor hemodynamic evidence of myocardial ischemia. Causes of nonischemic chest pain such as esophageal dysfunction, pulmonary hypertension, and mitral valve prolapse, should also be considered and pursued. Although chronic inflammation induced by Helicobacter pylori infection might play a part in the pathophysiology of CSX, one can conclude that nonischemic chest pain resulting from gastrointestinal disease such as esophagitis, gastritis cannot be completely excluded in the patients with CSX. We believe future large scale prospective cohort studies will be needed to solve that dilemma.

Possible role of Helicobacter pylori infection via microvascular dysfunction in cardiac syndrome X.

Recently, some investigators have reported seeing microvascular dysfunction in patients with cardiac syndrome X (CSX). In addition, Helicobacter pylori (H. pylori), a bacterium causing chronic gastritis and peptic ulcers, has recently been associated with CSX. Yet the mechanism(s) by which H. pylori infection leads to CSX is poorly understood. We propose a link between H. pylori and microvascular dysfunction infection in the development of CSX.

The relation between Helicobacter pylori infection and cardiac syndrome X: a preliminary study.

Cardiac syndrome X is defined by an angina pectoris with normal or near normal coronary angiogram.We evaluated the association of Helicobacter pylori (HP) infection with cardiac syndrome X (CSX). We studied 30 patients with CSX, 30 cases with stable angina and also 30 healthy controls. All three groups underwent urea breath test (UBT). Fifty percent (15 out of 30) of CSX patients had positive UBT result (> or =200 dpm), while two other groups did not have the positive results. Regarding high prevalence of HP infection in patients with CSX in our study and probable causative effect of chronic infection in coronary artery diseases, possible role of HP infection in the pathogenesis of CSX is suggested. However well designed clinical trial studies are needed to confirm this preliminary result.

Association of Helicobacter pylori infection with cardiac syndrome X.

INTRODUCTION: Cardiac syndrome X (CSX) includes chest pain, positive exercise stress test and/or radionuclide test for ischaemia and normal coronary angiography. There is no obvious aetiology for this syndrome. Some mechanisms such as endothelial dysfunction and oestrogen deficiency have been invoked. In this study, we surveyed the association of Helicobacter pylori (HP) infection with cardiac syndrome X. METHODS: HP infection was detected by urea breath test (UBT) in patients with cardiac syndrome X, and compared with a sex- and age-matched control group. Patients with dyspepsia and coronary spasm were excluded. Statistical analysis was carried out using chi-square test. RESULTS: 40 patients (29 females and 11 males) with cardiac syndrome X aged between 30 and 65 years (mean 45.51 +/- 5.03 years) were compared with a control group (28 females and 12 males) aged between 31 and 64 years old (mean 44.93 +/- 5.16 years). 95 percent of patients were HP infected, while only 47.5 percent of members of the control group were infected (p-value is less than 0.001). CONCLUSION: Considering the high prevalence of HP infection in patients with CSX in our sample and probable causative effect of chronic infection in vascular diseases, we believe that there is a probable role for HP infection in the pathogenesis of CSX.

Resolution of syndrome X after eradication of virulent CagA-positive Helicobacter pylori.

A 42-year-old man with chest pain was found to have ST depression in leads V1 through V4. The coronary arteries appeared normal on angiography. Positive results of ventricular pacing and acetylcholine test led to a diagnosis of syndrome X. Other studies revealed gastritis due to CagA-positive Helicobacter pylori. Classic therapy for angina did not resolve chest pain, but eradication of H. pylori led to disappearance of symptoms and negative test results.