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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Women, cardiac syndrome X, and microvascular heart disease
Heather M Arthur1, Pat Campbell, Paula J Harvey
1Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. arthurh@mcmaster.ca
Insights
Persistent chest pain with normal heart arteries, known as cardiac syndrome X (CSX), indicates a higher long-term cardiovascular disease risk than previously believed. This condition requires further research into its mechanisms and management.
Area of Science:
- Cardiology
- Pain Medicine
- Clinical Research
Background:
- Cardiac syndrome X (CSX) is characterized by angina, ischemia, and normal coronary arteries.
- CSX is associated with significant patient suffering, disability, and healthcare costs.
- Historically, the long-term prognosis of CSX was considered benign.
Purpose of the Study:
- To review the current understanding of CSX.
- To highlight the shift in perspective regarding the long-term cardiovascular disease risk in CSX patients.
- To explore proposed mechanisms and future research directions for CSX.
Main Methods:
- Literature review of existing studies on CSX.
- Analysis of epidemiological data related to CSX.
- Synthesis of current scientific understanding and clinical observations.
Main Results:
- New data suggest CSX is not benign and carries an increased cardiovascular disease risk.
- A significant proportion of patients with CSX face elevated long-term cardiovascular risks.
- The underlying mechanisms of CSX (cardiac vs. noncardiac) remain a subject of debate.
Conclusions:
- The prognosis for patients with CSX is less benign than previously assumed.
- CSX is linked to a substantial increase in cardiovascular disease risk.
- Future research should emphasize interdisciplinary collaboration between cardiovascular and pain scientists to advance CSX understanding.
Abstract:
New data suggest that persistent chest pain, despite normal coronary angiography, is less benign than previously thought. It has long been recognized that cardiac syndrome X (CSX) is associated with significant suffering, disability, and health care costs, but the biggest shift in thinking comes in terms of long-term risk. It is now recognized that the prognosis is not benign and that a significant proportion of patients are at increased cardiovascular disease risk. Of major debate is the question of whether the mechanisms that explain this chest pain are cardiac vs noncardiac. The most current definition of CSX is the triad of angina, ischemia, and normal coronary arteries, which is associated with an increased cardiovascular risk. This paper provides a review of CSX, epidemiology of the problem, proposed explanatory mechanisms, and important next steps in research. Central to this review is the proposition that new insights into CSX will be fostered by both clinical and scientific collaboration between cardiovascular and pain scientists.
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