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Background: Endocan is a recently introduced marker of endothelial dysfunction and is also associated with inflammation and atherosclerosis. To date, the relationship between cardiac syndrome X (CSX) and endocan has not been studied. The objective of this study was to compare the serum endocan levels of patients with CSX with those of control subjects.Patients and methods: In this study, 50 patients were included in the CSX group and 28 patients in the control group. Patients with pathological conditions that could potentially influence endothelial functions were excluded. Endocan serum concentrations were measured using an enzyme-linked immunosorbent assay.Results: The mean endocan level of the CSX group was significantly higher than that of the control group (3051.3 ± 1900.5 ng/l vs. 2088.1 ± 522.2 ng/l; p = 0.002). There was no difference between the two groups in terms of age, gender, hypertension, diabetes mellitus, dyslipidemia, and smoking status. In receiver operating characteristic (ROC) curve analysis, endocan levels greater than 2072 ng/l had a 72% sensitivity and 54% specificity (p = 0.002) for accurately predicting a diagnosis of CSX.Conclusion: The results of this study suggest that patients with CSX have higher endocan levels. Therefore, endocan may be valuable in helping uncover the underlying pathogenesis of CSX. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of Tongxinluo Capsule (通心络胶囊, TXL) for patients with cardiac syndrome X (CSX).Methods: 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.Results: 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.Conclusions: 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. [ABSTRACT FROM AUTHOR]

The frequency, presentation, prognosis, and treatment of myocardial ischemia differ in men and women. A large proportion of women who have 'normal' coronary arteries on angiography without any significant evidence of flow-limiting disease also have biochemical or imaging evidence of myocardial ischemia. In these women it is believed to be a dysfunction of coronary microcirculation and/or macrocirculation, or vasotonic angina (VA), that leads to abnormal vasoconstriction, and potentially to myocardial infarction, ventricular arrhythmias, and sudden death. Despite having a 'normal' or near normal coronary angiography, these women should therefore undergo additional testing with acetylcholine to assess endothelial function. Long-term survival is believed to be relatively good. Predictors of poorer prognosis include documentation of severe endothelial dysfunction and presence of concurrent angiographycally visible coronary atherosclerosis. Because atherosclerosis is common in patients with VA, medical and lifestyle interventions for preventing or treating atherosclerosis should be implemented when appropriate. Angiotensin converting enzyme inhibitors are the mainstays of medical therapy for VA. Other agents have been tried with variable success, including beta-blockers. There are no available data on any specific treatment of VA in women (versus men). [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: A count-based new technique from gated myocardial perfusion single-photon emission tomography (gMPS) was developed to allow the phase analysis providing information about the left ventricular (LV) regional discordance in contractility which is a measure of LV dyssynchrony. Since the phase analysis provides data for evaluating the dyssynchronous LV contraction, it has an important role in diagnosis and management of patients with left ventricular dysfunction. The aim of the study was to assess the presence of left ventricular dyssynchrony in patients with reversible perfusion defects on gMPS scans and normal or near normal coronary arteries at angiography. Methods: 32 patients (19 men, 59 %) with reversible mild perfusion defects on gMPS and normal coronary angiogram were retrospectively enrolled in the study. The peak of the phase histogram, the standard deviation of the phase distribution (PSD), the width of the band (PHB), and the symmetry and peakedness of the phase histogram, which are the assessment parameters for the LV dyssynchrony, were calculated from gMPS scans of patients by means of the phase analysis. Results: Although, five quantitative variables are derived from the phase analysis of gMPS, PSD and PHB are two quantitative indices to assess LV global mechanical dyssynchrony and measurements of PSD (men 24.96 ± 7.31, women 24.26 ± 10.07) and PHB (men 70.1 ± 13.99, women 71.0 ± 30.4) were significantly higher than the those reported in the literature ( p < 0.001). No significant differences in gMPS phase analysis indices were found between both sexes except kurtosis. Conclusion: As a conclusion, this study provides the phase analysis to detect LV mechanical dyssynchrony as new evidence supporting the concept that an abnormal scintigraphy finding, rather than being false-positive, may be an early marker of vasomotion changes associated with occult atherosclerosis in patients with normal coronary angiography findings. [ABSTRACT FROM AUTHOR]

Aims: Cardiac syndrome X (CSX) is characterized by exercise-induced angina, positive exercise stress-test responses and angiographically normal coronary arteries. The condition characteristically affects more women than men and is often associated with coronary microvascular dysfunction, i.e., abnormal vasodilatory responses. Recent clinical observations suggest that increased coronary vasoconstriction may have a pathogenic role in CSX. We therefore sought to assess the prevalence of increased epicardial and microvascular coronary vasoconstriction in women with CSX. Methods and results: Among 1,120 consecutive women with angina undergoing diagnostic coronary angiography 39 fulfilled criteria for CSX (mean age 63 ± 9 years) and were included in the study (27 also complained about rest angina). Five women without angina (mean age 64 ± 24 years) and normal coronary arteriograms served as controls. Patients and controls underwent intracoronary acetylcholine testing with a standardized protocol. Severe (≥75 % diameter reduction) epicardial constriction developed in 12 CSX patients (31 %) with reproduction of their angina in 10. All 12 patients showed diffuse epicardial constriction affecting mainly the distal coronary segments. Twenty-two CSX patients (56 %) experienced their usual angina without epicardial constriction of which 21 had ischemic ECG shifts. The remaining five CSX patients (13 %) had no angina or constriction in response to acetylcholine. None of the control patients had angina or constriction during ACH testing. Conclusion: Increased epicardial as well as microvascular coronary constriction in response to acetylcholine are frequent findings in women with CSX. The results indicate that inappropriate coronary constriction is likely to contribute to the anginal symptoms of these patients. The ACH-test may be useful in the clinical setting to unmask this vasomotor disorder. [ABSTRACT FROM AUTHOR]

Background: The pathophysiology of microvascular angina (cardiac syndrome X, CSX), (effort-induced angina, a positive response to exercise stress testing and angiographically normal coronary arteries) has not been fully elucidated. Various pathogenic mechanisms have been proposed, amongst which coronary microvascular dysfunction features prominently. Management of patients with microvascular angina is often challenging as a substantial number of patients does not respond to conventional anti-anginal therapy. In this study, we sought to assess the association between brachial artery FMD, high-sensitive C-reactive protein (hs-CRP) and cardiovascular risk factors including obesity in patients with cardiac syndrome X. Methods and results: Thirty-four consecutive CSX patients (29 female, mean age 60 ± 9 years) were recruited from a specialised CSX clinic. Twelve asymptomatic subjects (10 female, mean age 51 ± 12 years) with comparable cardiovascular risk factor profile served as controls. All participants underwent standardized computer-assisted FMD measurements and assessment of hs-CRP concentrations at study entry. Body mass index (BMI), used as a general measure of obesity was calculated as weight (kilograms) divided by height (meters squared). Compared to controls, CSX patients had significantly higher hs-CRP concentrations ( p = 0.003) and impaired FMD ( p < 0.01). Moreover, among the CSX patients, a correlation between FMD and hs-CRP ( r = −0.66, p < 0.01), FMD and BMI ( r = 0.377, p = 0.028), and hs-CRP and BMI ( r = −0.372, p = 0.030) was found. Conclusion: Impaired brachial artery FMD is significantly associated with elevated hs-CRP concentrations and BMI in patients with CSX. The results support the concept that low-grade inflammation and obesity may promote vascular dysfunction in these patients representing therapeutic targets for future research investigations. [ABSTRACT FROM AUTHOR]

Clinical reports on cardiac syndrome X (CSX) have been increasing in recent years. In general, CSX does not increase the cardiovascular mortality, but it can affect the patient's quality of life (QOL) and increase the incidence rates of cardiovascular and cerebrovascular events. Although a variety of drugs and therapies have been utilized in the clinical treatment, the management of CSX still represents a major challenge due to its unclear pathogenesis. It is necessary to explore more effective treatment programs. Many attempts have been made on trials of the Chinese medicine (CM) treatment for CSX and proved that CM has a certain advantage in efficacy to improve clinical symptoms and QOL. CM may provide a new approach for the effective treatment of CSX. [ABSTRACT FROM AUTHOR]

Microvascular angina (MVA) is an often overlooked cause of significant chest pain. Decreased myocardial perfusion secondary to dysregulated blood flow in the microvasculature can occur in the presence or absence of obstructive epicardial coronary artery disease. The corresponding myocardial ischemia and angina is now a well-established diagnosis, made by detection of decreased coronary flow reserve (CFR). Although low CFR and MVA are associated with poor prognosis, there is initial evidence for reversibility of this abnormal vascular regulation with aggressive medical therapy and control of associated risk factors. Current assessment of MVA is carried out predominantly during cardiac catheterization; however, noninvasive techniques to assess CFR are being developed, including PET, MRI, and CT modalities. Quantitative tracer techniques or imaging of metabolic disturbances reflecting ischemia will likely enhance diagnostic approaches for such patients as well as allow more frequent monitoring of response to therapy. [ABSTRACT FROM AUTHOR]

There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta-analysis yielded a pooled proportion of females of 0.56 ( n = 1,934 patients, with 95% confidence interval: 0.54–0.59). As much as 9 inclusion criteria and 43 exclusion criteria were found in the 57 articles. Applying these criteria to a population with normal coronary angiograms and treated in 1 year at a general hospital, the attributable CSX incidence varied between 3 and 11%. The many inclusion and exclusion criteria result in a wide range of definitions of CSX and these have large effects on the incidence. This shows the need for a generally accepted definition of CSX. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical effect of Liqi Kuanxiong Huoxue method (... LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circulation) in treating patients with cardiac syndrome X (CSX). Methods: The prospective, non-randomized controlled study was conducted on 51 selected patients with CSX, who were non-randomly assigned to 2 groups, the treated group treated with LKH in addition to the conventional treatment (32 patients), and the control group treated with conventional treatment (19 patients) like nitrate, diltiazem hydrochloride, etc. The treatment course was 14 days. The changes of such symptoms as angina pectoris, TCM syndrome and indexes of treadmill exercise test before and after treatment were observed. Results: After treatment, such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group (P<0.05); the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group (P<0.05). The treadmill exercise test showed that the maximal metabolic equivalent (Max MET), the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups, but the improvement in the treated group was better than that in the control group respectively (P<0.05). Conclusion: The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX. [ABSTRACT FROM AUTHOR]

Background:Angina with normal coronary arteries, cardiac syndrome X, is a diagnosis of exclusion. The exact mechanism of this clinical syndrome remains unclear. Although the prognosis is as good as equal to that of normal population, symptoms related with the syndrome impair largely quality of life. Mean platelet volume showing the platelet size is an indicator of platelet function. Larger platelets are more active than smaller ones. Methods and results: We designed a study, evaluated mean platelet volume of the patients with cardiac syndrome X (group A) and stable angina (group B) and investigated the relation between groups. Eighty patients with cardiac syndrome X with a mean age of 51.08 ± 9.79 years and 67 patients with stable angina with a mean age of 55.16 ± 11.96 years were studied. At the end of the study, mean platelet volume of group A was significantly higher than that of group B, 10.55 ± 1.08 fl vs. 9.39 ± 0.58 fl, respectively ( P < 0.001). Conclusion: Raised platelet size has been shown to be associated with adverse cardiac events. Mean platelet volume has increased in acute coronary syndromes and also in cardiac syndrome X in our study. Life style modification may optimize platelet size and improve symptoms in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)