Reversibility of stress-echo induced ST-segment depression by long-term oral n-3 PUFA supplementation in subjects with chest pain syndrome, normal wall motion at stress-echo and normal coronary angiogram.
BACKGROUND
Normal coronary arteries may coexist with abnormal coronary and systemic endothelial function in patients with chest pain. Recent work by the renowned Pisa echo-group elegantly suggests that isolated ST-segment depression during stress-echo (SE) can be used as a marker of coronary endothelial dysfunction, in the absence of stress-inducible wall motion abnormalities and in the absence of angiographically-significant coronary artery disease (CAD). The long chain n-3 polyunsaturated fatty acids (PUFAs) have been reported to possess several properties that may positively influence vascular function. The present study's hypothesis is that a 4 month-course of oral supplementation with n-3 PUFAs can reverse endothelial dysfunction.


METHODS
Subjects were selected on the basis of the following criteria: 1) reported chest pain syndrome, 2) significant ST-segment depression during an otherwise normal SE, 3) absence of angiographically-significant CAD. Subjects underwent a 4-month course of oral supplementation with commercially available n-3 PUFA, 1 g once a day. Normalization of endothelial dysfunction was defined, at the end of the supplementation period, by the absence of significant ST-segment depression during repeat SE. We tested the aforementioned hypothesis in a very small series of consecutive subjects, with the intent to produce a hypothesis-generating study.


RESULTS
Seven out of the total nine subjects enrolled (77.8%) had normal ST-segment during repeat SE performed after the 4 month course of therapy.


CONCLUSIONS
A striking rate of reversion of SE-induced ST-segment depression after oral n-3 PUFAs suggests reversion of coronary endothelial dysfunction; nonetheless these data need to be validated in larger, placebo-controlled studies.
Gaibazzi
Nicola
N
Cardiology Department, Ospedale Civile di Desenzano del Garda, Desenzano del Garda (BS), Italy. nicola.gaibazzi@inwind.it
Ziacchi
Vigilio
V
D000284:Administration, Oral; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy; D025401:Echocardiography, Stress; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies
D005231:Fatty Acids, Unsaturated