Cardiac syndrome X in Ireland: incidence and phenotype
J Dollard1,2, P Kearney3, T G Dinan4,5
1Department of Cardiology, Cork University Hospital, Cork, Ireland. jamesdollard@gmail.com.
Insights
Cardiac Syndrome X (CSX) is uncommon in Ireland, primarily affecting middle-aged women. Diagnosis and cardiology follow-up are crucial for managing its significant impact on quality of life.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Cardiac Syndrome X (CSX) presents as typical angina with signs of myocardial ischemia despite normal coronary angiograms, often linked to microvascular dysfunction.
- The global incidence of CSX is not well-established, and its prevalence in Ireland remains unknown.
Purpose of the Study:
- To determine the incidence of CSX at Cork University Hospital (CUH).
- To define the clinical characteristics (phenotype) of Irish patients diagnosed with CSX.
Main Methods:
- Patients undergoing coronary angiography at CUH over a 3-month period were assessed.
- CSX diagnosis followed standard criteria, with an extended 14-month recruitment for phenotyping.
Main Results:
- Only 1.3% (5 of 372) of patients investigated for chest pain met CSX criteria.
- Irish CSX patients were predominantly female (88%), mean age 59.2 years, with significant quality of life impairment comparable to obstructive coronary artery disease (CAD).
- No CSX patients received a discharge diagnosis or cardiology follow-up.
Conclusions:
- CSX is uncommon in Ireland, typically affecting middle-aged women with hyperlipidemia.
- CSX significantly impacts patients' quality of life, necessitating improved diagnosis and cardiology follow-up.
- Lack of awareness or acceptance of CSX in Ireland hinders proper patient management.
Background:
Cardiac syndrome X (CSX) is typical angina pectoris with objective signs of myocardial ischaemia despite a normal coronary angiogram and may be due to microvascular dysfunction. The incidence of CSX has not been greatly investigated worldwide and its incidence in Ireland is unknown.
Aims:
We aimed to determine the incidence of CSX in Cork University Hospital (CUH) and to establish the phenotype of the typical Irish CSX patient.
Methods:
All patients undergoing coronary angiography in CUH during regular working hours over a 3-month period were investigated. CSX was diagnosed using standard criteria. An extended recruitment period of 14 months allowed enrolment of a sufficient number of CSX patients to enable phenotyping.
Results:
Only 5 of 372 (1.3 %) patients undergoing angiography to investigate chest pain met the diagnostic criteria for CSX. None were given a discharge diagnosis of CSX or received cardiology follow-up. Irish CSX patients were predominantly female (88 %) with a mean age of 59.2 ± 6.6 years. Although they were significantly less functionally limited than patients with obstructive CAD, they had an equally substantial impairment in quality of life.
Conclusions:
CSX is relatively uncommon in Ireland and is most frequently seen in middle-aged women with hyperlipidaemia. It has significant impacts on patients' quality of life. None of the CSX patients were diagnosed as such, highlighting the lack of awareness or acceptance of this condition in Ireland. These patients require diagnosis and active cardiology follow-up to effectively manage their symptoms.
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