title: Chest pain in patients with arterial hypertension, angiographically normal coronary arteries and stiff aorta: the aortic pain syndrome.
abstract: BACKGROUND
  Arterial hypertension is often associated with a stiff aorta as a result of collagen accumulation in the aortic wall and may produce chest pain. In the present study, possible interrelationships between aortic function, collagen turnover and exercise-induced chest pain in patients with arterial hypertension and angiographically normal coronary arteries were investigated.
  
  
  METHODS
  Ninety-seven patients with arterial hypertension, angiographically normal coronary arteries and no evidence of myocardial ischemia on nuclear cardiac imaging during exercise test were studied. Of these, 43 developed chest pain during exercise (chest pain group) while 54 did not (no chest pain group). Carotid femoral pulse-wave velocity (PWVc-f) was used to assess the elastic properties of the aorta. Amino-terminal pro-peptides of pro-collagen type I, (PINP, reflecting collagen synthesis), serum telopeptides of collagen type I (CITP, reflecting collagen degradation), pro-metalloproteinase 1 (ProMMP-1), and tissue inhibitor of metalloproteinase 1 (TIMP-1, related to collagen turnover) were measured in plasma by immunoassay.
  
  
  RESULTS
  The chest pain group had higher PWVc-f, higher  and /CITP ratio, and lower proMMP-1/ TIMP-1 ratio compared to the no chest pain group. PWVc-f (t=2.53, p=0.02) and PINP (t=2.42, p=0.02) were independently associated with the presence of chest pain in multiple regression analysis.
  
  
  CONCLUSIONS
  Patients with arterial hypertension, exercise-induced chest pain and angiographically normal coronary arteries, without evidence of exercise-induced myocardial ischemia, had a stiffer aorta compared to those without chest pain. Alterations in collagen type I turnover that favor collagen accumulation in the aortic wall may contribute to aortic stiffening and chest pain in these patients.
authors: Dept of Cardiology, Democritus University of Thrace, Dragana,, Greece. dstakos@med.duth.gr
authors: Dimitrios A
authors: DA
authors: Stakos
authors: Dimitrios N
authors: DN
authors: Tziakas
authors: George
authors: G
authors: Chalikias
authors: Konstantina
authors: K
authors: Mitrousi
authors: Christina
authors: C
authors: Tsigalou
authors: Harisios
authors: H
authors: Boudoulas
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D015415:Biomarkers; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D020781:Matrix Metalloproteinase 1 / Q000097:blood*; D008875:Middle Aged; D063177:Pulse Wave Analysis; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood*; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers; D019715:Tissue Inhibitor of Metalloproteinase-1; D020781:Matrix Metalloproteinase 1