| Coronary microvascular function and cortical pain processing in patients with silent positive exercise testing and normal coronary arteries. | |
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MedLine Citation:
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PMID: 22459303 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article Date: 2012-03-27 |
Journal Detail:
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Title: The American journal of cardiology Volume: 109 ISSN: 1879-1913 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2012 Jun |
Date Detail:
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Created Date: 2012-06-04 Completed Date: 2012-10-18 Revised Date: 2012-12-07 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1705-10 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
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Institute of Cardiology, Università Cattolica del Sacro Cuore, Rome, Italy. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine
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diagnostic use Aged Blood Flow Velocity Case-Control Studies Cold Temperature Coronary Angiography Coronary Circulation / drug effects Coronary Vessels / physiopathology*, ultrasonography Echocardiography Echocardiography, Doppler Evoked Potentials, Somatosensory Exercise Test* False Positive Reactions Female Humans Male Microcirculation / drug effects Microvascular Angina / physiopathology*, ultrasonography Middle Aged Pain / physiopathology Vasodilator Agents / diagnostic use |
| Chemical | |
Reg. No./Substance:
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0/Vasodilator Agents; 58-61-7/Adenosine |
| Comments/Corrections | |
Comment In:
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Am J Cardiol. 2012 Nov 1;110(9):1386; author reply 1386-7
[PMID:
23059392
]
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Erratum In:
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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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