Structural and functional abnormality of systemic microvessels in cardiac syndrome X.
OBJECTIVE
Microvascular damage of coronary bed has been considered the main pathogenetic factor of cardiac syndrome X (chest pain, exercise-induced ischemic ST-segment changes and angiographically normal coronary arteries). Previous studies have demonstrated that vascular abnormalities are not confined to the heart, suggesting a peripheral vascular dysfunction. On the hypothesis of a generalized microvascular disturbance in cardiac syndrome X, we performed a morphologic and functional study of systemic microcirculation in patients with syndrome X compared to normal subjects.


RESULTS
Microvessels were evaluated with intravital videocapillaroscopy (VCP) executed in peripheral and conjunctival observation sites which explore micro and paramicrocirculation; biohumoral study included markers of inflammation and of endothelial function, coagulative-fibrinolytic system and lipid metabolism. Videocapillaroscopy showed several morphologic changes (present in high percent of patients with syndrome X and not in controls) and significant quantitative alterations (capillary density, granular flow score, alterations of vessel profile, length of capillary loop branches and of arteriole/venule diameter) which indicated a severe alteration of whole vessel structure and an important rearrangement of microvascular disposition. In a similar way, the humoral study showed some significant changes of endothelial (vWF, ICAM-1, E-sel, PAI-1), inflammatory (C-reactive protein (CRP), fibrinogen) and metabolic factors (HDL-chol) which are commonly associated with inflammatory response.


CONCLUSIONS
We conclude that patients with cardiac syndrome X exhibited some structural and functional alterations of systemic microvasculature; the pattern is similar to that detected in systemic inflammatory diseases and suggests a vascular lesion of inflammatory type. The same changes could be operating also in coronary microvessels of patients with syndrome X.
Pasqui
A L
AL
Department of Clinical Medicine and Immunology, Internal Medicine Division, University of Siena, Italy. pasquian@unisi.it
Puccetti
L
L
Di Renzo
M
M
Bruni
F
F
Camarri
A
A
Palazzuoli
A
A
Biagi
F
F
Servi
M
M
Bischeri
D
D
Auteri
A
A
Pastorelli
M
M
D000787:Angina Pectoris / Q000503:physiopathology*; D000788:Angina Pectoris, Variant / Q000503:physiopathology; D016022:Case-Control Studies; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000503:physiopathology*; D020678:Microscopic Angioscopy; D018715:Microscopy, Video; D008875:Middle Aged; D013577:Syndrome