Identification of syndrome X using intravascular ultrasound imaging and Doppler flow mapping

• Published in: Chinese medical journal Vol. 117; no. 4; pp. 521 - 527
• Main Author: 钱菊英 葛均波 樊冰 王齐兵 陈灏珠
• Format: Journal Article
• Language: English
• Published: China Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China%Department of Cardiology, University of Essen, 45147 Essen, Germany 01.04.2004
• Subjects: Adult; Aged; Coronary Angiography; Coronary Circulation; Female; Humans; Laser-Doppler Flowmetry; Male; Microvascular Angina - diagnosis; Microvascular Angina - physiopathology; Middle Aged; Ultrasonography, Interventional; X综合征; 临床特点; 多普勒超声; 影像学诊断; 血管内超声显像; Doppler ultrasound; syndrome X; coronany angiography
• ISSN: 0366-6999; 2542-5641

Background The purpose of this study was to assess the morphological changes and physiological function of coronary arteries in patients presenting with chest pain but having normal coronary angiograms, using intravascular ultrasound imaging (IVUS) and intracoronary Doppler (ICD) flow measurements, in order to elucidate the mechanism of syndrome X.Methods A total of 126 patients [67 males, 59 females, mean age (53. 1±13.0) years] who experienced chest pain but had normal coronary angiograms were included in this study. ICD flow measurements of the left anterior descending coronary artery (LAD) were performed using a Cardiometrics FIoMap Ⅱ system. Coronary flow velocity reserve (CFVR) was defined as the ratio of the average peak velocity during hyperemia to that at baseline, induced by an intracoronary bolus injection of 18μg adenosine. A 3.2F or 2. 9F 30 MHz mechanical rotating ultrasound catheter (CVIS,Boston Scientific) or a 3. OF 20MHz electronic ultrasound catheter (Endosonics) was used for IVUS.Results The mean CFVR value of the LAD was 2.71 ~ 0.74. Reduction of CFVR ( < 3. 0 ) was found in 82 of 126 (65. 1% ) patients. IVUS images of the LAD were available for 109 patients.Plaque formation was detected in 76/109 (69.7%) patients. Based on the presence or absence of plaque formation as well as the reduction or non-reduction of CFVR, patients were divided into four groups. Group Ⅰ (n =10), normal IVUS findings and normal CFVR; Group Ⅱ (n =23), normal IVUS findings with reduction in CFVR; Group Ⅲ (n = 29), IVUS evidence of plaque formation but normal CFVR; and Group Ⅳ (n =47), IVUS evidence of plaque formation with reduction in CFVR.Conclusion This study shows the important clinical value of a combination of IVUS and ICD in diagnosing patients with angiographically normal coronary arteries. Only 10% of patients studied(Group Ⅰ ) were found to be truly free of coronary disease, while 20% of patients (Group Ⅱ ) would be diaanosed as sufferina from syndrome X.