Increased aortic pulse and fractional pulse pressures in patients with cardiac syndrome X
Serkan Cay1, Umit Guray, Sule Korkmaz
1Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey. cayserkan@yahoo.com
Insights
Elevated aortic pulse pressure and fractional pulse pressure are significantly linked to cardiac syndrome X, a condition causing chest pain with normal arteries. These hemodynamic markers may aid in identifying patients with this syndrome.
Area of Science:
- Cardiology
- Vascular Physiology
- Diagnostic Biomarkers
Background:
- Cardiac syndrome X, or angina with normal coronary arteries, is a diagnosis of exclusion with unclear mechanisms.
- While prognosis is generally good, symptoms significantly impair quality of life.
- Aortic pulse pressure and fractional pulse pressure are established indicators of coronary heart disease risk.
Purpose of the Study:
- To evaluate aortic pulse and fractional pulse pressures in patients with cardiac syndrome X compared to controls.
- To investigate the association between these hemodynamic parameters and the presence of cardiac syndrome X.
Main Methods:
- A consecutive series of 126 patients with cardiac syndrome X and 76 controls were studied.
- Aortic systolic, diastolic, mean, and pulse pressures were measured; fractional pulse pressure was calculated.
- Patients were analyzed in tertiles of aortic pulse pressure and dichotomized by fractional pulse pressure levels.
Main Results:
- Aortic pulse and fractional pulse pressures were significantly higher in the cardiac syndrome X group.
- Increased aortic pulse pressure was strongly associated with cardiac syndrome X risk (ORs 6.72 and 29.94 for higher tertiles).
- Higher fractional pulse pressure also significantly increased cardiac syndrome X risk (OR 4.09).
Conclusions:
- Ascending aorta pulse and fractional pulse pressures are significantly associated with cardiac syndrome X.
- These associations remain significant and independent of age and other cardiovascular risk factors.
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 the normal population, symptoms related to the syndrome largely impair quality of life. Aortic pulse and fractional pulse pressures are strong and independent indicators of the risk of coronary heart disease. An increase in these hemodynamic parameters is significantly associated with the presence of coronary artery disease in men and women.
Methods And Results:
We evaluated aortic pulse and fractional pulse pressures of patients with cardiac syndrome X and control subjects, and investigated the relation between the two groups. One hundred and twenty-six patients with cardiac syndrome X with a mean age of 53.1 +/- 9.5 years and 76 patients without the syndrome with a mean age of 53.1+/-11.2 years were studied consecutively from May 2004 to May 2005. Aortic systolic, diastolic, mean and pulse pressures were measured and the fractional pulse pressure was calculated (aortic pulse pressure/mean pressure). Aortic pulse and fractional pulse pressures were significantly higher in the cardiac syndrome X group than in the control group (51 +/- 13 mmHg and 43+/-9 mmHg, p < 0.001; 0.54 +/- 0.11 and 0.47 +/- 0.08, p < 0.001, respectively). All patients were classified into tertiles of aortic pulse pressure level to evaluate whether aortic pulse pressure was associated with the presence of cardiac syndrome X in the study. The multiple-adjusted odds ratio of the risk of cardiac syndrome X was 6.72 (95% CI 2.76-16.37) for tertile 2 and 29.94 (95% CI 5.59-160.44) for tertile 3 of aortic pulse pressure level compared with tertile 1. In addition, all patients were divided into two groups as lower and higher levels of aortic fractional pulse pressure. The multiple-adjusted OR of the risk of cardiac syndrome X was 4.09 (95% CI 2.05-8.15) for the higher group compared with the lower group of aortic fractional pulse pressure level.
Conclusion:
Ascending aorta pulse and fractional pulse pressures are significantly associated with the presence of cardiac syndrome X and these associations are independent of age and other cardiovascular risk factors.
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