Key result
Cardiac syndrome X patients undergoing dobutamine stress exhibited severe chest pain and increased right anterior insula activity compared to healthy controls, despite no myocardial dysfunction.
Why the study?
Does dobutamine stress reveal altered central neural handling of afferent signals in patients with cardiac syndrome X compared to healthy volunteers?
Case-Control (n=16)
Does dobutamine stress reveal altered central neural handling of afferent signals in patients with cardiac syndrome X compared to healthy volunteers?
Patients with cardiac syndrome X exhibit altered central neural processing of afferent signals, specifically increased right insular activation during stress, which may explain their abnormal chest pain perception despite normal myocardial function.
Altered central processing may underlie chest pain in cardiac syndrome X; case-control data leave open causal mechanisms and therapeutic targets.
OBJECTIVE: To investigate the central neural contribution to chest pain perception in cardiac syndrome X (angina-like pain, ECG changes during stress, angiographically normal coronary arteriogram). SUBJECTS: Eight syndrome X patients and eight healthy volunteers. METHODS: Dobutamine stress using echocardiography to assess myocardial function, and positron emission tomography to measure changes in regional cerebral blood flow, as an index of neuronal activity. RESULTS: During similar doses of dobutamine, syndrome X patients and controls showed comparable regional cerebral blood flow changes in the hypothalamus, thalami, right orbito-frontal cortex, and anterior temporal poles, associated with the sensation of a fast or powerful heart beat. In patients, but not controls, the stress also generated severe chest pain associated with increased activity in the right anterior insula/frontal operculum junction. There were ischaemia-like ECG changes in the syndrome X patients, but no left ventricular dysfunction on echocardiography. Activation of the right insula during chest pain clearly distinguished the syndrome X patients from a group of patients with known coronary disease. CONCLUSIONS: Chest pain and ECG changes were not accompanied by demonstrable myocardial dysfunction in syndrome X patients, but altered central neural handling of afferent signals may contribute to the abnormal pain perception in these patients.
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Stuart D. Rosen (2002) conducted a case-control in Cardiac syndrome X (n=16). Cardiac syndrome X vs. Healthy volunteers was evaluated on Changes in regional cerebral blood flow and chest pain perception during dobutamine stress. Cardiac syndrome X patients undergoing dobutamine stress exhibited severe chest pain and increased right anterior insula activity compared to healthy controls, despite no myocardial dysfunction.
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