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Endothelial dysfunction, subangiographic atheroma, and unstable symptoms in patients with chest pain and normal

I D Cox1, J R Clague, J P Bagger

  • 1Cardiological Sciences Department, St. George's Hospital Medical School, London, U.K.

Clinical Cardiology
|October 4, 2000
PubMed

Insights

Endothelial dysfunction may cause unstable symptoms in patients with normal coronary arteriograms, but it is not linked to subangiographic atheroma. Further research is needed to understand this condition.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Patients with chest pain and normal coronary arteriograms (CPNA) can exhibit unstable symptoms and ischemia.
  • Repeat angiography is often negative, necessitating functional assessments for coronary vasomotor abnormalities.

Purpose of the Study:

  • To evaluate the link between endothelial dysfunction and subangiographic atheroma in CPNA patients with unstable symptoms.
  • To investigate coronary vasomotor responses and subangiographic atheroma in CPNA patients.

Main Methods:

  • Nine CPNA patients with unstable angina underwent repeat angiography.
  • Coronary epicardial and microvascular responses to vasodilators were assessed using quantitative angiography and Doppler flow.
  • Subangiographic atheroma was evaluated using intravascular ultrasound.

Main Results:

  • Three patients showed concordant epicardial and microvascular endothelial dysfunction, with two experiencing chest pain and ischemic ECG changes.
  • Six patients had significant subangiographic disease, related to cholesterol and hypertension history.
  • No direct relationship was found between endothelial dysfunction and the extent of subangiographic disease.

Conclusions:

  • Concordant epicardial and microvascular endothelial dysfunction may be significant in unstable CPNA patients.
  • This dysfunction does not appear directly related to the extent of subangiographic atheroma.
Abstract

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