The magnitude of coronary endothelial dysfunction correlated significantly with the extent of inducible myocardial ischemia in patients with chest pain (r = -0.44; P=0.015).
Observational (n=30)
Does the magnitude of coronary endothelial dysfunction correlate with the extent of inducible myocardial ischaemia in patients with chest pain and non-obstructed coronary arteries?
Abnormal vasomotion due to coronary endothelial dysfunction is associated with myocardial ischaemia in patients with chest pain and non-obstructed coronary arteries, with the magnitude of ischaemia correlating with the extent of dysfunction.
Effect estimate: r = -0.44 (95% CI -0.097 to -0.69)
p-value: p=0.015
AIMS: Coronary endothelial dysfunction (ED), by predisposing to abnormal vasomotion, may cause chest pain in individuals with non-obstructed coronary arteries. The aim of this study was to correlate the magnitude of coronary ED with the presence and extent of inducible myocardial ischaemia using body surface electrocardiogram (ECG) mapping in symptomatic patients. METHODS AND RESULTS: In 30 patients with chest pain and angiographically normal coronary arteries or mild atherosclerosis, we studied endothelium-dependent responses with acetylcholine (ACH) and endothelium-independent function with nitroglycerin and adenosine in the left anterior descending artery. Eighty-lead body surface ECG maps were collected at baseline and after each dose of ACH. There was a significant correlation between the maximal change in epicardial diameter with ACH and the magnitude of ST-segment shift r = -0.44 (95% CI: -0.097 to -0.69), P = 0.015. Patients with ≥ 0.05 mV ST-segment shift/lead had greater epicardial vasoconstriction (31.6 vs. 15.6%, P = 0.019), and lower coronary flow reserve (2.9 vs. 3.6, P = 0.047) compared with those with ST-segment shift 20% decrease in diameter or <50% increase in blood flow). CONCLUSIONS: This study demonstrates that abnormal vasomotion due to coronary ED is associated with myocardial ischaemia in patients with chest pain. The magnitude of ischaemia correlates with the extent of ED. A small subset of patients develop myocardial ischaemia during ACH infusion without significant abnormalities in epicardial or global microvascular endothelium-dependent blood flow responses.
Summers et al. (Wed,) conducted a observational in Chest pain with angiographically normal coronary arteries or mild atherosclerosis (n=30). Coronary endothelial dysfunction was evaluated on Correlation between the maximal change in epicardial diameter with acetylcholine and the magnitude of ST-segment shift (r = -0.44, 95% CI -0.097 to -0.69, p=0.015). The magnitude of coronary endothelial dysfunction correlated significantly with the extent of inducible myocardial ischemia in patients with chest pain (r = -0.44; P=0.015).
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