Skip to main content

Insights into the Pathophysiology of Syndrome X Obtained Using Positron Emission Tomography (PET)

  • Chapter
Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 213))

Abstract

In the last five years, many studies have been performed to try to improve understanding of the clinical condition of syndrome X (anginal quality chest pain, ischemic-like changes on the stress ECG yet a normal coronary arteriogram). In this chapter, we review advances in knowledge of the pathophysiology of this condition which have been obtained by means of positron emission tomography (PET). The context in which the PET studies have been performed, i.e. several invasive studies and a number of non-PET nuclear cardiological investigations, is also outlined. Finally, we attempt to arrive at a conclusion more substantive than the somewhat vague and mysterious closing comments about a “heterogeneous disorder” with which many authors on the subject have taken leave of their readers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Rose G, McCartney P, Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prevent Soc Med 1977; 31:42–48.

    CAS  Google Scholar 

  2. Green LH, Cohn PF, Holman BL, Adams DF, Markis JE. Regional myocardial blood flow in patients with chest pain syndromes and normal coronary arteriograms. Br Heart J 1978; 40: 242–249.

    Article  PubMed  CAS  Google Scholar 

  3. Opherk D, Zebe H, Weihe E, Mall G, Dtirr C, Gravert B, Mehmal HC, Schwartz F, Kubler W. Reduced coronary dilatory capacity and ultrastructural changes in the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 1981; 63: 817–825.

    Article  PubMed  CAS  Google Scholar 

  4. Cannon RO, Schenke WH, Leon MB, Rosing DR, Urqhart J, Epstein SE. Limited coronary flow reserve after dipyridamole in patients with ergonovine-induced coronary vasoconstriction. Circulation 1987; 75: 163–174.

    Article  PubMed  Google Scholar 

  5. Crake T, Canepa-Anson R, Shapiro L, Poole-Wilson PA. Continuous reading of coronary sinus oxygen saturation during atrial pacing in patients with coronary artery disease or syndrome X. Br Heart J 1988; 59: 31–38.

    Article  PubMed  CAS  Google Scholar 

  6. Epstein SE, Cannon RO. Site of increased resistance to coronary flow in patients with angina pectoris and normal epicardial coronary arteries. J Am Coll Cardiol 1986; 8: 459–461.

    Article  PubMed  CAS  Google Scholar 

  7. Kemp HG, Elliott WC, Gorlin R. The anginal syndrome with normal coronary arteriography. Trans Assoc Am Physicians 1967; 80: 59–70.

    PubMed  CAS  Google Scholar 

  8. Arbogast R, Bourassa MG. Myocardial function during atrial pacing in patients with angina pectoris and normal coronary arteriograms. Comparison with patients having significant coronary artery disease. Am J Cardiol 1973; 32:257–263.

    Article  PubMed  CAS  Google Scholar 

  9. Holdright DR. Chest pain with normal coronary arteries. Br J Hosp Med 1996; 56: 347–50.

    PubMed  CAS  Google Scholar 

  10. Chauhan A, Mullins PA, Gill R, Taylor G, Petch MC, Schofield PM. Coronary flow reserve and oesophageal dysfunction in syndrome X. Postgrad Med J 1996; 72: 99–104.

    Article  PubMed  CAS  Google Scholar 

  11. Sanderson JE, Woo KS, Chung HK, Chan WW, Tse LK, White HD. The effect of transcutaneous electrical nerve stimulation on coronary and systemic haemodynamics in syndrome X. Coron Artery Dis 1996; 7: 547–52.

    Article  PubMed  CAS  Google Scholar 

  12. Chauhan A, Petch MC, Schofield PM. Cardio-oesophageal reflex in humans as a mechanism for “linked angina’ Eur Heart J 1996; 17: 407–13.

    Article  PubMed  CAS  Google Scholar 

  13. Chauhan A, Mullins PA, Petch MC, Schofield PM. Is coronary flow reserve in response to papaverine really normal in syndrome X? Circulation. 1994; 89: 1998–2004.

    Article  PubMed  CAS  Google Scholar 

  14. Holdright DR, Lindsay DC, Clarke D, Fox K, Poole-Wilson PA, Collins P. Coronary flow reserve in patients with chest pain and normal coronary arteries. Br Heart J. 1993; 70: 513–9.

    Article  PubMed  CAS  Google Scholar 

  15. Chauhan A, Mullins PA, Taylor G, Petch MC, Schofield PM. Effect of hyperventilation and mental stress on coronary blood flow in syndrome X. Br Heart J 1993; 69: 516–24.

    Article  PubMed  CAS  Google Scholar 

  16. Meeder JG, Blanksma PK, van der Wall EE, Willemsen AT, Pruim J; Anthonio RL, de Jong RM, Vaalburg W, Lie KI Coronary vasomotion in patients with syndrome X: evaluation with positron emission tomography and parametric myocardial perfusion imaging. Eur J Nucl Med. 1997; 24: 530–7.

    PubMed  CAS  Google Scholar 

  17. Fragasso G, Rossetti E, Dosio F, Gianolli L, Pizzetti G, Cattaneo N, Fazio F, Chierchia SL. High prevalence of the thallium-201 reverse redistribution phenomenon in patients with syndrome. Eur Heart J 1996; 17: 1482–7.

    Article  PubMed  CAS  Google Scholar 

  18. Meeder JG, Blanksma PK, Crijns HJ, Anthonio RL, Pruim J, Brouwer J, de Jong RM, van der Wall EE, Vaalburg W, Lie KI. Mechanisms of angina pectoris in syndrome X assessed by myocardial perfusion dynamics and heart rate variability. Eur Heart J 1995; 16: 1571–7.

    PubMed  CAS  Google Scholar 

  19. Inobe Y, Kugiyama K, Morita E, Kawano H, Okumura K, Tomiguchi S, Tsuji A, Kojima A, Takahashi M, Yasue H. Role of adenosine in pathogenesis of syndrome X: assessment with coronary hemodynamic measurements and thallium-201 myocardial single-photon emission computed tomography. J Am Coll Cardiol 1996; 28: 890–6.

    Article  PubMed  CAS  Google Scholar 

  20. Kao CH, Wang SJ, Ting CT, Chen YT.99mTc sestamibi myocardial SPECT in syndrome X. Clin Nucl Med 1996; 21: 280–3.

    Article  PubMed  CAS  Google Scholar 

  21. Palleschi L, Gianni W, De Vincentis G, Banci M, Sottosanti G, Ierardi M, Scopinaro F, Marigliano V. Dipyridamole technetium-99m Sestamibi imaging in the diagnosis of syndrome X. Angiology. 1996; 47: 369–73.

    Article  PubMed  CAS  Google Scholar 

  22. Kao CH, Wang SJ, Ting CT, Chen YT. Thallium-201 myocardial SPET in strictly defined syndrome X. Nucl Med Commun 1995; 16: 640–6.

    Article  PubMed  CAS  Google Scholar 

  23. Thorley PJ, Ball J, Sheard KL, Sivananthan UM. Evaluation of 99mTc-tetrofosmin as a myocardial perfusion agent in routine clinical use. Nucl Med Commun 1995; 16: 733–40.

    Article  PubMed  CAS  Google Scholar 

  24. Rosano GM, Peters NS, Kaski JC, Mavrogeni SI, Collins P, Underwood SR, Poole-Wilson PA. Abnormal uptake and washout of thallium-201 in patients with syndrome X and normal-appearing scans. Am J Cardiol 1995; 75: 400–2.

    Article  PubMed  CAS  Google Scholar 

  25. Rosen SD, Uren NG, Kaski J-C, Tousoulis D, Davies GJ, Camici PG. Coronary Vasodilator Reserve, Pain Perception and Gender in Patients with Syndrome X. Circulation 1994; 90: 50–60.

    Article  PubMed  CAS  Google Scholar 

  26. Galassi AR, Crea F, Araujo LI, Lammertsma AA, Pupita G, Yamomoto Y, Rechavia E, Jones T, Kaski J-C, Maseri A. Comparison of regional myocardial blood flow in syndrome X and one-vessel coronary artery disease. Am J Cardiol 1993; 72: 134–139.

    Article  PubMed  CAS  Google Scholar 

  27. Tweddel AC, Martin W, Hutton I. Thallium scans in syndrome X. Br Heart J 1992; 68: 48–50.

    Article  PubMed  CAS  Google Scholar 

  28. Rosen SD, Camici PG. Syndrome X: radionuclide studies of myocardial perfusion in patients with chest pain and normal coronary arteriograms [editorial] Eur J Nucl Med 1992; 19: 311–4.

    CAS  Google Scholar 

  29. Geltman EM, Henes CG, Sennef MJ, Sobel BE, Bergman SR. Increased myocardial perfusion at rest and diminished perfusion reserve in patients with angina and angiographically normal coronary arteries. J Am Coll Cardiol 1990; 16: 586–595.

    Article  PubMed  CAS  Google Scholar 

  30. Camici PG, Gistri R, Lorenzoni R, Sorace O, Michelassi C, Bongiomi MG, Salvadori PA, L’Abbate A. Coronary reserve and exercise ECG in patients with chest pain and normal coronary angiograms. Circulation 1992; 86: 179–186.

    Article  PubMed  CAS  Google Scholar 

  31. Galassi AR, Kaski J-C, Pupita G, Vejar M, Crea F, Maseri A. Lack of evidence for alpha-adrenergic receptor-mediated mechanisms in the genesis of ischemia in syndrome X. Am J Cardiol 1989; 64: 264–269.

    Article  PubMed  CAS  Google Scholar 

  32. Lorenzoni R, Rosen SD, Camici PG. Effect of selective a, blockade on resting and hyperemic myocardial blood flow in normal humans. Am J Physiol 1996; 271: H1302–H1306.

    PubMed  CAS  Google Scholar 

  33. Camici PG, Rosen SD. Does positron emission tomography contribute to the management of clinical cardiac problems? Eur Heart J 1996; 17: 174–181.

    Article  PubMed  CAS  Google Scholar 

  34. Baig MW, Sheard K, Thorley PJ, Rees MR, Tan LB. The use of dobutamine stress thallium scintigraphy in the diagnosis of syndrome X. Postgrad Med J 1992; 68 Suppl 2: S20–4.

    PubMed  Google Scholar 

  35. Kataoka T, Shih WJ. False-positive myocardial perfusion scintigraphy in syndrome X. Semin-NuclMed. 1997; 27: 186–9.

    Article  CAS  Google Scholar 

  36. Uren NG, Camici PG, Melin JA, Bol A, de Bruyne B, Radvan J, Olivotto I, Rosen SD, Impallomeni M and Wijns W. The effect of ageing on the coronary vasodilator reserve in man. J Nucl Med 1995; 36: 2032–2036.

    PubMed  CAS  Google Scholar 

  37. Hoffman JIE. Heterogeneity of myocardial blood flow. Bas Res Cardiol 1995; 90: 103–111.

    Article  CAS  Google Scholar 

  38. Rosen SD, Boyd H, Lorenzoni R, Kaski J-C, Camici PG. Effects of a1 blockade on myocardial blood flow in patients with cardiac syndrome X. Circulation 1997; 96: I-625.

    Google Scholar 

  39. Nihoyannopoulos P, Kaski JC, Crake T, Maseri A. Absence of myocardial dysfunction during pacing stress in patients with syndrome X. J Am Coll Cardiol 1991;18:1463–1470.

    Article  PubMed  CAS  Google Scholar 

  40. Camici PG, Marraccini P, Lorenzoni R, Buzzigoli G, Pecori N, Perissinotto A, Ferrannini E, L’Abbate A, Marzilli M: Coronary hemodynamics and myocardial metabolism in patients with syndrome X: response to pacing stress. J Am Coll Cardiol 1991;17:1461–1470.

    Article  PubMed  CAS  Google Scholar 

  41. Panza JA, Laurienzo JM, Curiel RV, Unger EF, Quyyumi AA, Dilsizian V, Cannon RO. Investigation of the mechanism of chest pain in patients with angiographically normal coronary arteries using transesophageal dobutamine stress echocardiography. J Am Coll Cardiol 1997; 29: 293–301.

    Article  PubMed  CAS  Google Scholar 

  42. Rosano GM, Kaski JC, Arie S, Pereira WI, Horta P, Collins P, Pileggi F, Poole-Wilson PA. Failure to demonstrate myocardial ischemia in patients with angina and normal coronary arteries. Evaluation by continuous coronary sinus pH monitoring and lactate metabolism. Eur Heart J 1996; 17: 1175–80.

    Article  PubMed  CAS  Google Scholar 

  43. Shapiro LM, Crake T, Poole-Wilson PA. Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterization. Br Med J 1988; 296: 170–171.

    Article  CAS  Google Scholar 

  44. Cannon RO, Quyyumi AA, Schenke WH, Fananapazir L, Tucker EE, Gaughan AM, Gracely RH, Cattau EL, Epstein SE. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol 1990; 16: 1359–1366.

    Article  PubMed  Google Scholar 

  45. Eriksson B, Svedenhag J, Martinsson A, Sylvén C. Effect of epinephrine infusion on chest pain in syndrome X in the absence of signs of myocardial ischemia. Am J Cardiol. 1995; 75: 241–245.

    Article  PubMed  CAS  Google Scholar 

  46. Turiel M, Galassi AR, Glazier JJ, Kaski JC, Maseri A: Pain threshold and tolerance in women with syndrome X and women with stable angina pectoris. Am J Cardiol 1987; 60:503–507.

    Article  PubMed  CAS  Google Scholar 

  47. Rosen SD, Paulesu E, Frith CD, Jones T, Davies GJ, Frackowiak RSJ, Camici PG. Central neural correlates of angina pectoris as a model of visceral pain. Lancet 1994; 344: 147–150.

    Article  PubMed  CAS  Google Scholar 

  48. Rosen SD, Paulesu E, Nihoyannopoulos P, Tousoulis D, Frackowiak RSJ, Frith CD, Jones T and Camici PG. Silent ischemia as a central problem: regional brain activation compared in silent and painful myocardial ischemia. Ann Int Med 1996; 124: 939–949.

    PubMed  CAS  Google Scholar 

  49. Raichle M. Circulatory and metabolic correlates of brain function in normal humans In: Mountcastle VB, Plum F, Geiger SR eds. Handbook of Physiology. Section 1: The nervous system. Vol V Higher functions of the brain Part 2, Chapter 16. Bethesda Md, USA: American Physiological Society, 1987: 643–674.

    Google Scholar 

  50. Friston KJ, Frackowiak RSJ. Imaging functional anatomy. In: Lassen NA. Ingvar DH, Raichle ME, Friberg L eds. Brain work and mental activity, Alfred Benzon symposium vol 31, Copenhagen, Munksgaard 1991: 267–279.

    Google Scholar 

  51. Rosen SD, Paulesu E, Frackowiak RSJ, Camici PG. Regional Brain Activation Compared in Angina Pectoris and Syndrome X. Circulation 1995; 92: 1–651.

    Article  Google Scholar 

  52. Cannon RO, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB, Geraci MF, Black BC, Uhde TW, Waclawiw MA, et al. Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 1994; 330: 1411–7.

    Article  PubMed  Google Scholar 

  53. Cannon RO. The sensitive heart. A syndrome of abnormal cardiac pain perception [clinical conference] J Am Med Assoc 1995; 273: 883–7.

    Google Scholar 

  54. Marcus ML, Wilson RF, White CW. Methods of measurement of myocardial blood flow in patients: A critical review. Circulation 1987; 76: 245–53.

    Article  PubMed  CAS  Google Scholar 

  55. Camici PG, Marraccini P, Gistri R, Salvadori PA, Sorace O, L’Abbate A. Adrenergically mediated coronary vasoconstriction in patients with syndrome X. Cardiovasc Drugs Ther. 1994; 8: 221–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media New York

About this chapter

Cite this chapter

Rosen, S.D., Camici, P.G. (1999). Insights into the Pathophysiology of Syndrome X Obtained Using Positron Emission Tomography (PET). In: Kaski, J.C. (eds) Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management. Developments in Cardiovascular Medicine, vol 213. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5181-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-5181-2_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-7360-5

  • Online ISBN: 978-1-4615-5181-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics