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Two Syndromes X

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Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 213))

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Abstract

There are now two syndromes X of interest to cardiovascular physicians - (1) “cardiac” syndrome X - angina without coronary arteriographic explanation [1], and (2) “metabolic” syndrome X - the epidemiological association of hypertension, noninsulin-dependent diabetes (NIDDM), dyslipidemia and coronary artery disease as described by Reaven in 1988 [2]. Both seem for the present to remain appropriately, albeit confusingly named, for each at root remains something of an enigma.

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References

  1. Kemp HG. Editorial: Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol 1973; 32:375–376.

    Article  PubMed  Google Scholar 

  2. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988;37:1595–1607.

    Article  PubMed  CAS  Google Scholar 

  3. Dart AM, Davies HA, Dalai J, Ruttley M, Henderson AH. “Angina” and normal coronary arteriograms: a follow-up study. Eur Heart J 1980; 1:97–100.

    PubMed  CAS  Google Scholar 

  4. Dean JD, Jones CJH, Hutchison SJ, Peters JR, Henderson AH. Hyperinsulinemia and microvascular angina (“Syndrome X”). Lancet 1991; 337:456–457.

    Article  PubMed  CAS  Google Scholar 

  5. Botker HE, Moller N, Oversen P, et al. Insulin resistance in microvascular angina (syndrome X). Lancet 1993; 342:136–140.

    Article  PubMed  CAS  Google Scholar 

  6. Goodfellow J, Owens DR, Henderson AH. Cardiovascular Syndromes X, endothelial dysfunction and insulin resistance. Diabetes res clin pract 1996; 31(Suppl):S163–S171.

    Article  PubMed  Google Scholar 

  7. Reaven GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities - the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334:952–957.

    Article  Google Scholar 

  8. Henderson AH. Endothelial dysfunction: a reversible clinical measure of atherogenic susceptibility and cardiovascular inefficiency. Int J Cardiol 1997; 62(Suppl I):S43–S48.

    Article  PubMed  Google Scholar 

  9. Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshita A. Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993; 328:1659–1664.

    Article  PubMed  CAS  Google Scholar 

  10. Vrints CJM, Bult H, Hitter E, Herman AG, Snoeck JP. Impaired endothelium-dependent cholinergic coronary vasodilatation in patients with angina and normal coronary arteriograms. J Am Coll Cardiol 1992; 19:21–31.

    Article  PubMed  CAS  Google Scholar 

  11. Koren W, Koldanov R, Peleg E, Rabinowitz B, Rosenthal T. Enhanced red cell sodium hydrogen exchange in microvascular angina. Eur Ht J 1997; 18:1296–1299.

    Article  CAS  Google Scholar 

  12. Laakso M, Edelman SV, Brechtel G, Baron AD. Decreased effect of insulin to stimulate skeletal muscle blood flow in obese man. A novel mechanism for insulin resistance. J Clin Invest 1990; 85:1844–1852.

    Article  PubMed  CAS  Google Scholar 

  13. Steinberg HO, Brechtel G, Johnson A, Fineberg N, Baron AD. Insulin-mediated skeletal muscle vasodilatation is nitric oxide dependent. J Clin Invest 1994; 94:1172–1179.

    Article  PubMed  CAS  Google Scholar 

  14. Scherrer U, Randin D, Vollenweider P, Vollenweider L, Nicod P. Nitric oxide release accounts for insulin’s vascular effects in humans. J Clin Invest 1994; 94:2511–2515.

    Article  PubMed  CAS  Google Scholar 

  15. Baron AD. The coupling of glucose metabolism and perfusion in human skeletal muscle. The potential role of endothelium-derived nitric oxide. Diabetes 1996; 45(Suppl í):S105–S109.

    Article  PubMed  CAS  Google Scholar 

  16. Lillioja S, Young AA, Cutter CL, et al. Skeletal muscle capillary density and fiber type are possible determinants of in vivo insulin resistance in man. J Clin Invest 1987; 80:415–424.

    Article  PubMed  CAS  Google Scholar 

  17. Barker DJP, Hales CN, Fall CHD, Osmond C, Phipps K, Clark PMS. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993; 36:62–67.

    Article  PubMed  CAS  Google Scholar 

  18. Yajnik CS, Fall CHD, Vaidya U, et al. Fetal growth and glucose and insulin metabolism in four-year-old Indian children. Diabet Med 1995; 12:330–336.

    Article  PubMed  CAS  Google Scholar 

  19. Phillips DIW, Hirst S, Clark PMS, Hales CN, Osmond C. Fetal growth and insulin secretion in adult life. Diabetologia 1994; 37:592–596.

    Article  PubMed  CAS  Google Scholar 

  20. Snoeck A, Remade C. Reussens B, Hoet JJ. Effect of a low protein diet during pregnancy on the fetal rat endocrine pancreas. Biol Neonate 1990; 57:107–118.

    Article  PubMed  CAS  Google Scholar 

  21. Desai M, Byrne CD, Zhang J, Petry CJ, Lucas A, Hales CN. Programming of hepatic insulin-sensitive enzymes in offspring of rat dams fed a protein-restricted diet. Am J Physiol 1997; 272:G1083–G1090.

    PubMed  CAS  Google Scholar 

  22. Dahri S, Snoeck A, Reusens-Billen B, Remade C, Hoet JJ. Islet function in offspring of mothers on low protein diet during gestation. Diabetes 1991; 40:115–120.

    PubMed  CAS  Google Scholar 

  23. Langley SC, Jackson AA. Increased systolic blood pressure in adult rats induced by fetal exposure to maternal low protein diets. Clin Sci 1994; 86:217–222.

    PubMed  CAS  Google Scholar 

  24. Leeson CPM, Whincup PH, Cook DG, et al. Flow mediated dilatation in 9- to Il-year-old children. The influence of intrauterine and childhood factors. Circulation 1997; 96:2233–2238.

    Article  PubMed  CAS  Google Scholar 

  25. Goodfellow J, Bellamy MF, Ramsey MW, Lewis MJ, Davies DP, Henderson AH. Endothelial function is impaired in fit young adults of low birth weight. Cardiovasc Res (in press).

    Google Scholar 

  26. Henderson AH. St Cyre’s Lecture: Endothelium in control. Br Heart J 1991; 65:116–125.

    Article  PubMed  CAS  Google Scholar 

  27. Utriainen T, Nuitila P, Takalala T, et al. Intact insulin stimulation of skeletal muscle blood flow, its heterogeneity and redistribution but not of glucose uptake in non-insulin-dependent diabetes mellitus. J Clin Invest 1997; 100:777–785.

    Article  PubMed  CAS  Google Scholar 

  28. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990’s. Nature 1993; 362:801–809.

    Article  PubMed  CAS  Google Scholar 

  29. Griffith TM, Edwards DH, Davies RU, Harrison TJ, Evans KT. EDRF co-ordinates the behaviour of vascular resistance vessels. Nature 1987; 329:442–445.

    Article  PubMed  CAS  Google Scholar 

  30. Griffith TM, Edwards DH. EDRF supresses chaotic pressure oscillations in an isolated resistance artery without influencing their intrinsic complexity. Am J Physiol 1994; 266:H1786–1800.

    PubMed  CAS  Google Scholar 

  31. Nagi DK, Hendra TJ, Ryle Ai, et al. The relationships of concentrations of insulin, intact proinsulin, and 32–33 split proinsulin with cardiovascular risk factors in type II (non-insulin-dependent) diabetic subjects. Diabetologia 1990; 33:532–537.

    Article  PubMed  CAS  Google Scholar 

  32. Haffner SM, Mykkanen L, Valdez RA, et al. Disproportionately increased proinsulin levels are associated with the insulin resistance syndrome. J Clin Endocrin Metab 1994; 79:1806–1810.

    Article  CAS  Google Scholar 

  33. Fowden AL. The role of insulin in prenatal growth. J Devel Physiol 1989;12:173–182.

    CAS  Google Scholar 

  34. Godfrey KM, Robinson S, Hales CN, Barker DJP, Osmond C, Taylor KP. Nutrition in pregnancy and the concentration of proinsulin, 32–33 split proinsulin, insulin and C-peptide in cord plasma. Diabetic Med 1997; 13:868–873.

    Article  Google Scholar 

  35. Ito A, Egashira K, Kadokami T, et al. Chronic inhibition of endothelium-derived nitric oxide synthesis causes coronary microvascular structural changes and hyperreactivity to seotonin in pigs. Circulation 1995; 92:2636–2644.

    Article  PubMed  CAS  Google Scholar 

  36. Nihoyannopoulos P, Kaski JC, Crake T, Maseri A. Absence of myocardial dysfunction during stress in patients with syndrome X. J Am Coll Cardiol 1991; 18:1463–1470.

    Article  PubMed  CAS  Google Scholar 

  37. Rosen SD, Uren NG, Kaski IC, Tousoulis D, Davies GJ, Camici PC. Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X. Circulation 1994; 90:50–60.

    Article  PubMed  CAS  Google Scholar 

  38. Panza JA, Laurenzio JM, Curiel RV, et al. Investigation of the mechanism of chest pain in patients with angiographically normal coronary arteries using transoesophageal dobutamine stress echocardiography. J Am Coll Cardiol 1997; 29:293–301.

    Article  PubMed  CAS  Google Scholar 

  39. Opherk D, Zebe H, Schuler C, Weihe E, Mall C, Kubler W. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary angiograms. Circulation 1981; 63:817–825.

    Article  PubMed  CAS  Google Scholar 

  40. Cannon RO, Watson RM, Rosing DR, Epstein S. Angina caused by reduced vasodilator reserve of the small coronary arteries. J Am Coll Cardiol 1983; 1:1359–1373.

    Article  PubMed  Google Scholar 

  41. Hutchison SJ, Poole-Wilson PA, Henderson AH. Angina with normal coronary arteries: a review. Q J Med 1989; 72:677–688.

    PubMed  CAS  Google Scholar 

  42. Galassi AR, Crea F, Araujo LI, et al. Comparison of regional myocardial blood flow in syndrome X and one-vessel coronary artery disease. Am J Cardiol. 1993; 72:134–139.

    Article  CAS  Google Scholar 

  43. Poole-Wilson PA. Potassium and the heart. Clin Endocrinol Metab 1984;13:249–268.

    Article  PubMed  CAS  Google Scholar 

  44. Geltman EM, Henes CC, Sennef MJ, Sobel BE, Bergman SR. Increased myocardial perfusion at rest and diminished perfusion reserve in patients with angina and angiographically normal coronary arteries. J Am Coll Cardiol 1990; 16:586–597.

    Article  PubMed  CAS  Google Scholar 

  45. Botker HE, Sonne HS, Bagger JP, Nielsen TT. Impact of impaired coronary flow reserve and insulin resistance on myocardial energy metabolism in patients with syndrome X. Am J Cardiol 1997; 79:1615–1622.

    Article  PubMed  CAS  Google Scholar 

  46. Shapiro LM, Crake T, Poole-Wilson PA. Is altered cardiac sensation responsible for chest pain in patients with normal coronaries? Clinical observation during cardiac catheterization. Br Med J 1988; 296:170–171.

    Article  CAS  Google Scholar 

  47. Cannon RO, Quyyumi AA, Schenke W, et al. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol 1990; 16:1359–1366.

    Article  PubMed  Google Scholar 

  48. Chauhan A, Mullins PA, Thuraisingham SI, Taylor G, Petch MC, Schofield PM. Abnormal cardiac pain perception in syndrome X. J Am Coll Cardiol 1994; 24:329–335.

    Article  PubMed  CAS  Google Scholar 

  49. Egashira K, Hirooka Y, Kuga T, Mohri M, Takeshita A. Effects of Larginine supplementation on endothelium-dependent coronary vasodilation in patients with angina pectoris and normal coronary angiograms. Circulation 1996; 94:130–134.

    Article  PubMed  CAS  Google Scholar 

  50. Bellamy MF, Goodfellow J, Tweddel AC, Lewis MJ, Henderson AH. Syndrome X and endolthelial dysfunction. Cardiovasc Res (in press).

    Google Scholar 

  51. Hori M, Inoue M, Kitakaze M, et al. Role of adenosine in hyperaemic response of coronary blood flow in microembolisation. Am J Physiol 1986; 250:H5O9–H518.

    Google Scholar 

  52. Kostic MM, Schrader J. Role of nitric oxide in reactive hyperaemia of the guinea pig heart. Circulation Res 1992; 70:208–212.

    Article  PubMed  CAS  Google Scholar 

  53. Sylven C, Jonzon B, Edlund A. Angina pectoris-like pain provoked by i.v. bolus of adenosine: relationship to coronary sinus blood flow, heart rate and blood pressure in healthy volunteers. Eur Heart J 1989; 10:48–54.

    Article  PubMed  CAS  Google Scholar 

  54. Bumstock G. A unifying purinergic hypothesis for the initiation of pain. Lancet 1996; 347:1604–1605.

    Article  Google Scholar 

  55. Dart C, Standen NB. Adrenosine-activated potassium current in smooth muscle cells isolated from the pig coronary artery. J Physiol 1993; 471:767–786.

    PubMed  CAS  Google Scholar 

  56. Lewis NP, Hutchinson SJ, Willis N, Henderson AH. Syndrome X and hyperventilation. Br Heart J 1991; 65:94–96.

    Article  PubMed  CAS  Google Scholar 

  57. Banning AP, Lewis NP, Northridge DB, Elborn JS, Henderson AH. Perfusion/ventilation mismatch during exercise in chronic heart failure: an analysis of circulatory determinants. Br Ht J 1995; 74:2733.

    Google Scholar 

  58. Emdin M, Picano E, Lattanzi F, L’Abatte A. Improved exercise capacity with acute aminophylline administration in patients with syndrome X. J Am Coll Cardiol 1989; 14:1450–1453.

    Article  PubMed  CAS  Google Scholar 

  59. Maseri A, Crea F, Kaski JC, Crake T. Mechanisms of angina pectoris syndrome X. J Am Coll Cardiol 1991; 17:499–506.

    Article  PubMed  CAS  Google Scholar 

  60. Inobe Y, Kugiyama K, Morita E, et al. Role of adenosine in pathogenesis of syndrome X: assessment with coronary haemodynamic measurements and thallium -201 myocardial single-photon emission computed tomography. J Am Coll Cardiol 1996; 28:890–896.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Andrew Henderson
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Editors and Affiliations

  1. St George’s Hospital Medical School, London, UK

    Juan Carlos Kaski MD, MRCP, FACC, FESC (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group) (BHF Sugden Reader in Clinical Cardiology and Consultant Cardiologist, Head of Coronary Artery Disease Research Group)

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© 1999 Springer Science+Business Media New York

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Henderson, A. (1999). Two Syndromes X. In: Kaski, J.C. (eds) Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management. Developments in Cardiovascular Medicine, vol 213. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5181-2_23

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  • DOI: https://doi.org/10.1007/978-1-4615-5181-2_23

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7360-5

  • Online ISBN: 978-1-4615-5181-2

  • eBook Packages: Springer Book Archive

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