Document Detail

Coronary microvascular function and cortical pain processing in patients with silent positive exercise testing and normal coronary arteries.
MedLine Citation:
PMID:  22459303     Owner:  NLM     Status:  MEDLINE    
ST-segment depression during exercise stress testing in asymptomatic subjects showing normal coronary arteries is considered a "false-positive" result. Coronary microvascular dysfunction, however, might be a possible cause of ST-segment depression in these cases. We assessed the coronary blood flow response to adenosine and to cold pressor test in the left anterior descending artery, using transthoracic Doppler echocardiography in 14 asymptomatic subjects with exercise-induced ST-segment depression and normal coronary arteries (group 1), 14 patients with microvascular angina (group 2), and 14 healthy subjects (group 3). Flow-mediated dilation was assessed in the brachial artery. Central pain processing was assessed using cortical laser evoked potentials during chest and right hand stimulation with 3 sequences of painful stimuli. The coronary blood flow response to adenosine was 1.8 ± 0.4, 1.9 ± 0.5, and 3.1 ± 0.9 in groups 1, 2, and 3, respectively (p <0.001). The corresponding coronary blood flow responses to the cold pressor test were 1.74 ± 0.4, 1.53 ± 0.3, and 2.3 ± 0.6 (p <0.001). The flow-mediated dilation was 5.5 ± 2.3%, 4.6 ± 2.4%, and 9.8 ± 1.2% in the 3 groups, respectively (p <0.001). The laser evoked potential N2/P2 wave amplitude decreased throughout the 3 sequences of stimulation in groups 1 and 3 but not in group 2 (chest, -19 ± 22%, +11 ± 42% and -36 ± 12%, p <0.001; right hand, -22 ± 25%, +12 ± 43% and -30 ± 20%, p = 0.009; in groups 1, 2, and 3). In conclusion, exercise stress test-induced ST-segment depression in asymptomatic subjects with normal coronary arteries cannot be considered as a simple false-positive result, because it can be related to coronary microvascular dysfunction. The different symptomatic state compared to patients with microvascular angina can, at least in part, be explained by differences in cortical processing of neural pain stimuli.
Antonino Di Franco; Gaetano A Lanza; Antonio Di Monaco; Alfonso Sestito; Priscilla Lamendola; Roberto Nerla; Pierpaolo Tarzia; Daniela Virdis; Catello Vollono; Massimiliano Valeriani; Filippo Crea
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Publication Detail:
Type:  Journal Article     Date:  2012-03-27
Journal Detail:
Title:  The American journal of cardiology     Volume:  109     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-04     Completed Date:  2012-10-18     Revised Date:  2012-12-07    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1705-10     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy.
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MeSH Terms
Adenosine / diagnostic use
Blood Flow Velocity
Case-Control Studies
Cold Temperature
Coronary Angiography
Coronary Circulation / drug effects
Coronary Vessels / physiopathology*,  ultrasonography
Echocardiography, Doppler
Evoked Potentials, Somatosensory
Exercise Test*
False Positive Reactions
Microcirculation / drug effects
Microvascular Angina / physiopathology*,  ultrasonography
Middle Aged
Pain / physiopathology
Vasodilator Agents / diagnostic use
Reg. No./Substance:
0/Vasodilator Agents; 58-61-7/Adenosine
Comment In:
Am J Cardiol. 2012 Nov 1;110(9):1386; author reply 1386-7   [PMID:  23059392 ]
Erratum In:
Am J Cardiol. 2012 Jul 1;110(1):165

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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