Coronary microvascular dysfunction is associated with ischemic-like electrocardiogram during exercise in patients with anginal chest pain and normal coronary angiograms

Jaw Wen Chen, Chih Tai Ting, Ching Iuan Chen, Guang Yuan Mar, Nai Wei Hsu, Shih Pu Wang, Mau Song Chang

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

Abstract

To determine the possible mechanism of the ischemic-like electrocardiogram (ECG) during exercise in the presence of anginal chest pain and normal coronary angiograms, both a treadmill exercise test (TET) and coronary hemodynamic study were prospectively performed in 33 consecutive patients (18 females and 15 males, aged 48 ± 10 years) with angina of unknown cause. Although baseline characteristics and coronary hemodynamics were similar between patients with (TET+, n = 17) and those without (TET-, n = 16) ischemic-like ECG during TET, effort angina was more frequently seen in the former group (p < 0.01). Compared to TET- patients, TET+ patients had a significantly lower maximum great cardiac Vein flow (GCVF, 108.8 ± 47.0 vs 146.4 ± 23.4 ml/min, p = 0.007), higher minimum coronary vascular resistance (0.94 ± 0.41 vs 0.61 ± 0.09 mmHg/ml/min., p = 0.003), and lower corrected GCVF (GCVF/rate-pressure product, 0.0087 ± 0.0036 vs 0.0125 ± 0.0019, p = 0.001) after dipyridamole infusion (0.56 mg/kg for 4 min.). Though coronary flow reserve was significantly lower in TET+ than in TET- patients (2.26 ± 0.59 vs 3.08 ± 0.48, p = 0.0001), myocardial oxygen consumption and myocardial efficiency (rate-pressure product/myocardial oxygen consumption) were still similar between these two groups after dipyridamole infusion. Thus, coronary microvascular dysfunction rather than altered cardiac metabolism could contribute to effort angina and ischemic-like ECG during exercise in patients with anginal chest pain and normal coronary angiograms.

Original languageEnglish
Pages (from-to)865-878
Number of pages14
JournalJapanese Heart Journal
Volume37
Issue number6
DOIs
Publication statusPublished - Nov 1996
Externally publishedYes

Keywords

  • Chest pain
  • Coronary flow reserve
  • Ischemic ECG
  • Normal coronary angiogram
  • Syndrome X
  • Treadmill exercise test

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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