Document Detail


Endothelial function predicts future development of coronary artery disease: a study of women with chest pain and normal coronary angiograms.
MedLine Citation:
PMID:  15136498     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The prognosis for women with chest pain and angiographically normal coronary arteries is believed to be totally benign. Previous studies, however, did not account for the delay of a decade or so in the development of coronary artery disease that women may experience. METHODS AND RESULTS: This study assessed long-term follow-up of 42 women with de novo angina, evidence of reversible myocardial perfusion defects on SPECT, and normal coronary angiograms. At recruitment, all women underwent endothelial function testing (intracoronary acetylcholine) during catheterization. Patients were followed up for >10 years. Angiography was repeated at the end of the follow-up in 37 patients. At recruitment, 22 patients developed diffuse vasoconstriction during acetylcholine in the absence of identifiable focal coronary spasm (acetylcholine-positive group). The remaining 20 patients showed vasodilation (acetylcholine-negative group). At the end of follow-up, in the acetylcholine-positive group, 1 patient developed cardiac death, 13 still complained of chest pain, and 8 had remission of symptoms. In the acetylcholine-negative group, all patients showed complete resolution of chest pain beginning 6 to 36 months after baseline assessment. Angiography showed development of coronary artery disease in the 13 symptomatic patients in the acetylcholine-positive group. CONCLUSIONS: In women with angiographically normal-appearing coronary arteries, persistence of chest pain over the years often relates to development of coronary artery disease. Endothelial dysfunction in a setting of normal coronary arteries is a sign of future development of atherosclerosis.
Authors:
Raffaele Bugiardini; Olivia Manfrini; Carmine Pizzi; Fiorella Fontana; Gianluigi Morgagni
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Publication Detail:
Type:  Journal Article     Date:  2004-05-10
Journal Detail:
Title:  Circulation     Volume:  109     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-02     Completed Date:  2004-12-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2518-23     Citation Subset:  AIM; IM    
Affiliation:
University of Bologna, Dipartimento di Medicina Interna, Cardioangiologia, Epatologia (Padiglione 11), Via Massarenti 9, 40138 Bologna, Italy. raffaele.bugiardini@unibo.it
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MeSH Terms
Descriptor/Qualifier:
Acetylcholine / administration & dosage,  diagnostic use
Adrenergic beta-Antagonists / therapeutic use
Adult
Aged
Angina Pectoris / drug therapy,  etiology*,  physiopathology,  radiography,  radionuclide imaging
Calcium Channel Blockers / therapeutic use
Cohort Studies
Coronary Angiography*
Coronary Circulation
Coronary Disease / epidemiology*
Coronary Vessels
Disease Progression
Endothelium, Vascular / physiopathology*
Female
Heart Catheterization
Humans
Injections, Intra-Arterial
Isosorbide Dinitrate / administration & dosage,  diagnostic use
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Time Factors
Tomography, Emission-Computed, Single-Photon
Vasodilation / drug effects
Vasodilator Agents / administration & dosage,  diagnostic use
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Calcium Channel Blockers; 0/Vasodilator Agents; 51-84-3/Acetylcholine; 87-33-2/Isosorbide Dinitrate

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


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