Chest pain in patients with 'normal angiography': Could it be cardiac?

International Journal of Evidence-Based Healthcare

Volumn 11, Issue 1, 2013, Pages 56-68

  Di Fiore, David P ^a   Beltrame, John F ^a  

^a UNIVERSITY OF ADELAIDE   (Australia)

Author keywords

Coronary slow flow phenomenon; Microvascular angina; Microvascular spasm; Syndrome X; Variant angina

Indexed keywords

ANGIOCARDIOGRAPHY; CORONARY ARTERY SPASM; DIFFERENTIAL DIAGNOSIS; EDITORIAL; HUMAN; PSYCHOLOGICAL ASPECT; SYNDROME X; THORAX PAIN; VARIANT ANGINA PECTORIS;

ANGINA PECTORIS, VARIANT; CHEST PAIN; CORONARY ANGIOGRAPHY; CORONARY VASOSPASM; DIAGNOSIS, DIFFERENTIAL; HUMANS; MICROVASCULAR ANGINA;

EID: 84877888312     PISSN: 17441595     EISSN: 17441609     Source Type: Journal    
DOI: 10.1111/1744-1609.12002     Document Type: Editorial

References (113)

1. Glagov S, Wisenberg E, Zarins C, Stankunavicius R, Kolettis G. Compensatory enlargement of human atherosclerotic coronary arteries. N Eng J Med 1987; 316: 1371-1375.
2. Nissen SE, Gurley JC, Grines CL, Booth DC, McClure R, Berk M etal. Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation 1991; 84(3): 1087-1099.
3. Likoff W, Segal BL, Kasparian H. Paradox of normal selective coronary arteriograms in patients considered to have unmistakable coronary heart disease. N Engl J Med 1967; 276(19): 1063-1066.
4. Bugiardini R, Manfrini O, De Ferrari GM. Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography. Arch Intern Med 2006; 166(13): 1391-1395.
5. Johnson BD, Shaw LJ, Pepine CJ, Reis SE, Kelsey SF, Sopko G etal. Persistent chest pain predicts cardiovascular events in women without obstructive coronary artery disease: results from the NIH-NHLBI-sponsored Women's Ischaemia Syndrome Evaluation (WISE) study. Eur Heart J 2006; 27(12): 1408-1415.
6. Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N. A variant form of angina pectoris: Preliminary report. Am J Med 1959; 27: 375-388.
7. Gianelly R, Mugler F, Harrison DC. Prinzmetal's variant of angina pectoris with only slight coronary atherosclerosis. Calif Med 1968; 108(2): 129-132.
8. Annonymous Variant angina with normal coronary arteriogram. Lancet 1970; 760(1): 1328-1329.
9. Cheng T, Bashour T, Kelser GJ, Weiss L, Bacos J. Variant angina of Prinzmetal with normal coronary arteriograms. A variant of the variant. Circulation 1973; 47(3): 476-485.
10. Yasue H, Touyama M, Shimamoto M, Kato H, Tanaka S, Akiyama F. Role of autonomic nervous system in the pathogenesis of Prinzmetal's variant form of angina. Circulation 1974; 50(3): 534-539.
11. Beltrame JF, Sasayama S, Maseri A. Racial heterogeneity in coronary artery vasomotor reactivity: differences between Japanese and Caucasian patients. Journal of the American College of Cardiology 1999; 33(6): 1442-1452.
12. Yasue H, Kugiyama K. Coronary spasm: clinical features and pathogenesis. Internal medicine 1997; 36(11): 760-765.
13. Chen HS, Pinto DS. Prinzmetal's Angina. N Engl J Med 2003; 349(1): E1.
14. Yasue H, Takizawa A, Nagao M, Nishida S, Horie M, Kubota J etal. Long-term prognosis for patients with variant angina and influential factors. Circulation 1988; 78(1): 1-9.
15. Lanza GA, Crea F. Primary coronary microvascular dysfunction: clinical presentation, pathophysiology, and management. Circulation 2010; 121(21): 2317-2325.
16. Beltrame JF, Crea F, Camici P. Advances in Coronary Microvascular Dysfunction. Heart Lung and Circulation 2009; 18(1): 19-27.
17. Arbogast R, Bourassa MG. Myocardial function during atrial pacing in patients with angina and normal arteriograms. Am J Cardiol 1973; 32(3): 257-263.
18. Kemp HG. Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms. Am J Cardiol 1973; 32(3): 375-376.
19. Vermeltfoort IA, Raijmakers PG, Riphagen, II, Odekerken DA, Kuijper AF, Zwijnenburg A etal. Definitions and incidence of cardiac syndrome X: review and analysis of clinical data. Clinical research in cardiology : official journal of the German Cardiac Society 2010; 99(8): 475-481.
20. Singh M, Singh S, Arora R, Khosla S. Cardiac syndrome X: current concepts. International journal of cardiology 2010; 142(2): 113-119.
21. Kaski JC, Valenzuela Garcia LF. Therapeutic options for the management of patients with cardiac syndrome X. European heart journal 2001; 22(4): 283-293.
22. Opherk D, Zebe H, Weihe E, Mall G, Durr C, Gravert B etal. Reduced coronary dilator capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation 1981; 63(4): 817-825.
23. Cannon RO, 3rd, Watson RM, Rosing DR, Epstein SE. Angina caused by reduced vasodilator reserve of the small coronary arteries. Journal of the American College of Cardiology 1983; 1(6): 1359-1373.
24. Cannon Rd, Schenke W, Quyyumi A, Bonow R, Epstein S. Comparison of exercise testing with studies of coronary flow reserve in patients with microvascular angina. Circulation 1991 83(5 Suppl): 77-81.
25. Cannon RO, 3rd, Epstein SE. "Microvascular angina" as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol 1988; 61(15): 1338-1343.
26. Opherk D, Schuler G, Wetterauer K, Manthey J, Schwarz F, Kubler W. Four year follow-up study in patients with angina pectoris and normal coronary arteriograms ("Syndrome X"). Circulation 1989; 80(6): 1610-1616.
27. Cannon Rd, Peden D, Berkebile C, Kaliner M, Epstein S. Bronchial hyperreactivity to methacholine in patients with microvascular angina. Circulation 1988; 78(4 Suppl II):II: 374.
28. Cannon Rd, Cattau E, Yakshe P, Maher K, Schenke W, Benjamin S etal. Coronary flow reserve, esophageal motility, and chest pain in patients with angiographically normal coronary arteries. Am J Med 1990; 88(3): 217-222.
29. Cannon ROd, Quyyumi AA, Schenke WH, Fananapazir L, Tucker EE, Gaughan AM etal. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. J Am Coll Cardiol 1990; 16(6): 1359-1366.
30. Cannon ROd, Watson RM, Rosing DR, Epstein SE. Efficacy of calcium channel blocker therapy for angina pectoris resulting from small-vessel coronary artery disease and abnormal vasodilator reserve. Am J Cardiol 1985; 56(4): 242-246.
31. Cannon RO, 3rd, Quyyumi AA, Mincemoyer R, Stine AM, Gracely RH, Smith WB etal. Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med 1994; 330(20): 1411-1417.
32. Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries: A new angiographic finding. Am Heart J 1972; 84(1): 66-71.
33. Beltrame JF. Defining the coronary slow flow phenomenon. Circulation journal: official journal of the Japanese Circulation Society 2012; 76(4): 818-820.
34. Leone MC, Gori T, Fineschi M. The coronary slow flow phenomenon: a new cardiac "Y" syndrome? Clinical hemorheology and microcirculation 2008; 39(1-4): 185-190.
35. Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon - a new coronary microvascular disorder. Cardiology 2002; 97(4): 197-202.
36. Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary Slow Flow. Circ J 2012; 76(4): 936-942.
37. Beltrame JF, Limaye SB, Wuttke R, Horowitz JD. Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon. Am Heart J 2003; 146(1): 84-90.
38. Fineschi M, Bravi A, Gori T. The "slow coronary flow" phenomenon: evidence of preserved coronary flow reserve despite increased resting microvascular resistances. International journal of cardiology 2008; 127(3): 358-361.
39. Kopetz V, Kennedy J, Heresztyn T, Stafford I, Willoughby SR, Beltrame JF. Endothelial function, oxidative stress and inflammatory studies in chronic coronary slow flow phenomenon patients. Cardiology 2012; 121(3): 197-203.
40. Sezgin N, Barutcu I, Sezgin AT, Gullu H, Turkmen M, Esen AM etal. Plasma nitric oxide level and its role in slow coronary flow phenomenon. Int Heart J 2005; 46(3): 373-382.
41. Pekdemir H, Polat G, Cin VG, Camsari A, Cicek D, Akkus MN etal. Elevated plasma endothelin-1 levels in coronary sinus during rapid right atrial pacing in patients with slow coronary flow. International journal of cardiology 2004; 97(1): 35-41.
42. Mangieri E, Macchiarelli G, Ciavolella M, Barilla F, Avella A, Martinotti A etal. Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Catheterization and cardiovascular diagnosis 1996; 37(4): 375-381.
43. Kurtoglu N, Akcay A, Dindar I. Usefulness of oral dipyridamole therapy for angiographic slow coronary artery flow. Am J Cardiol 2001; 87(6): 777-779.
44. Beltrame JF, Turner SP, Leslie SL, Solomon P, Freedman SB, Horowitz JD. The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon. Journal of the American College of Cardiology 2004; 44(1): 57-62.
45. Ball CJ, Wilson DP, Turner SP, Saint DA, Beltrame JF. Heterogeneity of L- and T-channels in the vasculature: rationale for the efficacy of combined L- and T-blockade. Hypertension 2009; 53(4): 654-660.
46. Tiryakioglu S, Tiryakioglu O, Ari H, Basel MC, Bozat T. Effects of nebivolol on endothelial function and exercise parameters in patients with slow coronary flow. Clin Med Cardiol 2009; 3: 115-119.
47. Sadamatsu K, Tashiro H, Yoshida K, Shikada T, Iwamoto K, Morishige K etal. Acute effects of isosorbide dinitrate and nicorandil on the coronary slow flow phenomenon. American journal of cardiovascular drugs : drugs, devices, and other interventions 2010; 10(3): 203-208.
48. Topal E, Ozdemir R, Barutcu I, Aksoy Y, Sincer I, Akturk E etal. The effects of trimetazidine on heart rate variability in patients with slow coronary artery flow. Journal of electrocardiology 2006; 39(2): 211-218.
49. Mohri M, Koyanagi M, Egashira K, Tagawa H, Ichiki T, Shimokawa H etal. Angina pectoris caused by coronary microvascular spasm. Lancet 1998; 351(9110): 1165-1169.
50. Mohri M, Shimokawa H, Hirakawa Y, Masumoto A, Takeshita A. Rho-kinase inhibition with intracoronary fasudil prevents myocardial ischemia in patients with coronary microvascular spasm. J Am Coll Cardiol 2003; 41(1): 15-19.
51. Masumoto A, Mohri M, Takeshita A. Three-year follow-up of the Japanese patients with microvascular angina attributable to coronary microvascular spasm. Int J Cardiol 2001; 81(2-3): 151-156.
52. Bruschke AV, Proudfit WL, Sones FM, Jr. Clinical course of patients with normal, and slightly or moderately abnormal coronary arteriograms. A follow-up study on 500 patients. Circulation 1973; 47(5): 936-945.
53. Proudfit WL, Bruschke VG, Sones FM, Jr. Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10-year follow-up of 521 patients. Circulation 1980; 62(4): 712-717.
54. Wielgosz AT, Fletcher RH, McCants CB, McKinnis RA, Haney TL, Williams RB. Unimproved chest pain in patients with minimal or no coronary disease: a behavioral phenomenon. American heart journal 1984; 108(1): 67-72.
55. Kemp HG, Kronmal RA, Vlietstra RE, Frye RL. Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. Journal of the American College of Cardiology 1986; 7(3): 479-483.
56. Sanchez-Recalde A, Galeote G, Moreno R, Dobarro D, Gomez-Rubin MC, Calvo L etal. Long-term prognostic value of endothelial dysfunction in patients with chest pain and angiographically normal coronary arteries. Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 2009; 28(7-8): 785-791.
57. Kemp HG, Jr., Vokonas PS, Cohn PF, Gorlin R. The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. The American journal of medicine 1973; 54(6): 735-742.
58. Pasternak RC, Thibault GE, Savoia M, DeSanctis RW, Hutter AM, Jr. Chest pain with angiographically insignificant coronary arterial obstruction. Clinical presentation and long-term follow-up. The American journal of medicine 1980; 68(6): 813-817.
59. Isner JM, Salem DN, Banas JS, Jr., Levine HJ. Long-term clinical course of patients with normal coronary arteriography: follow-up study of 121 patients with normal or nearly normal coronary arteriograms. American heart journal 1981; 102(4): 645-653.
60. Papanicolaou MN, Califf RM, Hlatky MA, McKinnis RA, Harrell FE, Jr., Mark DB etal. Prognostic implications of angiographically normal and insignificantly narrowed coronary arteries. The American journal of cardiology 1986; 58(13): 1181-1187.
61. Sullivan AK, Holdright DR, Wright CA, Sparrow JL, Cunningham D, Fox KM. Chest pain in women: clinical, investigative, and prognostic features. Bmj 1994; 308(6933): 883-886.
62. Sicari R, Palinkas A, Pasanisi EG, Venneri L, Picano E. Long-term survival of patients with chest pain syndrome and angiographically normal or near-normal coronary arteries: the additional prognostic value of dipyridamole echocardiography test (DET). European heart journal 2005; 26(20): 2136-2141.
63. Bemiller CR, Pepine CJ, Rogers AK. Long-term observations in patients with angina and normal coronary arteriograms. Circulation 1973; 47(1): 36-43.
64. Day LJ, Sowton E. Clinical features and follow-up of patients with angina and normal coronary arteries. Lancet 1976; 2(7981): 334-337.
65. Ockene IS, Shay MJ, Alpert JS, Weiner BH, Dalen JE. Unexplained chest pain in patients with normal coronary arteriograms: a follow-up study of functional status. The New England journal of medicine 1980; 303(22): 1249-1252.
66. DeMaria AN, Lee G, Amsterdam EA, Low R, Mason DT. The anginal syndrome with normal coronary arteries. Etiologic and prognostic considerations. JAMA : the journal of the American Medical Association 1980; 244(8): 826-828.
67. Lantinga LJ, Sprafkin RP, McCroskery JH, Baker MT, Warner RA, Hill NE. One-year psychosocial follow-up of patients with chest pain and angiographically normal coronary arteries. The American journal of cardiology 1988; 62(4): 209-213.
68. Radice M, Giudici V, Marinelli G. Long-term follow-up in patients with positive exercise test and angiographically normal coronary arteries (syndrome X). The American journal of cardiology 1995; 75(8): 620-621.
69. Lavey EB, Winkle RA. Continuing disability of patients with chest pain and normal coronary arteriograms. Journal of chronic diseases 1979; 32(3): 191-196.
70. Faxon DP, McCabe CH, Kreigel DE, Ryan TJ. Therapeutic and economic value of a normal coronary angiogram. The American journal of medicine 1982; 73(4): 500-505.
71. Bass C, Wade C, Hand D, Jackson G. Patients with angina with normal and near normal coronary arteries: clinical and psychosocial state 12 months after angiography. Br Med J (Clin Res Ed) 1983; 287(6404): 1505-1508.
72. Juelsgaard P, Ronnow Sand NP. Somatic and social prognosis of patients with angina pectoris and normal coronary arteriography: a follow-up study. International journal of cardiology 1993; 39(1): 49-57.
73. Brush JE, Jr., Cannon RO, 3rd, Schenke WH, Bonow RO, Leon MB, Maron BJ etal. Angina due to coronary microvascular disease in hypertensive patients without left ventricular hypertrophy. The New England journal of medicine 1988; 319(20): 1302-1307.
74. Rosano GM, Kaski JC, Arie S, Pereira WI, Horta P, Collins P etal. Failure to demonstrate myocardial ischaemia in patients with angina and normal coronary arteries. Evaluation by continuous coronary sinus pH monitoring and lactate metabolism. European heart journal 1996; 17(8): 1175-1180.
75. Buffon A, Rigattieri S, Santini SA, Ramazzotti V, Crea F, Giardina B etal. Myocardial ischemia-reperfusion damage after pacing-induced tachycardia in patients with cardiac syndrome X. American journal of physiology Heart and circulatory physiology 2000; 279(6): H2627-2633.
76. Rosen SD, Uren NG, Kaski JC, Tousoulis D, Davies GJ, Camici PG. Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X. Circulation 1994; 90(1): 50-60.
77. Cannon RO, 3rd, 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(1): 163-174.
78. Bottcher M, Botker HE, Sonne H, Nielsen TT, Czernin J. Endothelium-dependent and -independent perfusion reserve and the effect of L-arginine on myocardial perfusion in patients with syndrome X. Circulation 1999; 99(14): 1795-1801.
79. Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P etal. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. The New England journal of medicine 2002; 346(25): 1948-1953.
80. Wiedermann JG, Schwartz A, Apfelbaum M. Anatomic and physiologic heterogeneity in patients with syndrome X: an intravascular ultrasound study. Journal of the American College of Cardiology 1995; 25(6): 1310-1317.
81. Mosseri M, Yarom R, Gotsman MS, Hasin Y. Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation 1986; 74(5): 964-972.
82. Huang PH, Chen YH, Chen YL, Wu TC, Chen JW, Lin SJ. Vascular endothelial function and circulating endothelial progenitor cells in patients with cardiac syndrome X. Heart 2007; 93(9): 1064-1070.
83. Lanza GA, Giordano A, Pristipino C, Calcagni ML, Meduri G, Trani C etal. Abnormal Cardiac Adrenergic Nerve Function in Patients With Syndrome X Detected By [123I]Metaiodobenzylguanidine Myocardial Scintigraphy. Circulation 1997; 96(3): 821-826.
84. Lee WL, Chen JW, Lin SJ, Hsu NW, Chang MS, Ting CT. Parasympathetic withdrawal antedates dynamic myocardial ischemia in patients with syndrome X. International journal of cardiology 1998; 66(3): 253-260.
85. Quyyumi AA, Cannon RO, 3rd, Panza JA, Diodati JG, Epstein SE. Endothelial dysfunction in patients with chest pain and normal coronary arteries. Circulation 1992; 86(6): 1864-1871.
86. Okyay K, Cengel A, Sahinarslan A, Tavil Y, Turkoglu S, Biberoglu G etal. Plasma asymmetric dimethylarginine and L-arginine levels in patients with cardiac syndrome X. Coronary artery disease 2007; 18(7): 539-544.
87. Lanza GA, Luscher TF, Pasceri V, Shaw SG, Buffon A, Montenero AS etal. Effects of atrial pacing on arterial and coronary sinus endothelin-1 levels in syndrome X. The American journal of cardiology 1999; 84(10): 1187-1191.
88. Lanza GA, Sestito A, Cammarota G, Grillo RL, Vecile E, Cianci R etal. Assessment of systemic inflammation and infective pathogen burden in patients with cardiac syndrome X. The American journal of cardiology 2004; 94(1): 40-44.
89. Li J-J, Zhu C-G, Nan J-L, Li J, Li Z-C, Zeng H-S etal. Elevated circulating inflammatory markers in female patients with cardiac syndrome X. Cytokine 2007; 40(3): 172-176.
90. Tousoulis D, Davies GJ, Asimakopoulos G, Homaei H, Zouridakis E, Ahmed N etal. Vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 serum level in patients with chest pain and normal coronary arteries (syndrome X). Clinical cardiology 2001; 24(4): 301-304.
91. On YK, Park R, Hyon MS, Kim SK, Kwon YJ. Are low total serum antioxidant status and elevated levels of C-reactive protein and monocyte chemotactic protein-1 associated with cardiac syndrome X? Circulation journal : official journal of the Japanese Circulation Society 2005; 69(10): 1212-1217.
92. Senen K, Ileri M, Alper A, Yetkin F, Atak R, Hisar I etal. Increased levels of soluble adhesion molecules E-selectin and P-selectin in patients with cardiac syndrome X. Angiology 2005; 56(3): 273-277.
93. Pasqui AL, Puccetti L, Di Renzo M, Bruni F, Camarri A, Palazzuoli A etal. Structural and functional abnormality of systemic microvessels in cardiac syndrome X. Nutrition, metabolism, and cardiovascular diseases: NMCD 2005; 15(1): 56-64.
94. Cosin-Sales J, Pizzi C, Brown S, Kaski JC. C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms. Journal of the American College of Cardiology 2003; 41(9): 1468-1474.
95. Lanza GA, Andreotti F, Sestito A, Sciahbasi A, Crea F, Maseri A. Platelet aggregability in cardiac syndrome X. European heart journal 2001; 22(20): 1924-1930.
96. Neumann FJ, Waas W, Zimmermann R, Haupt H, Tillmanns H, Kubler W. Haemorheologic studies in patients with reduced coronary vasodilator capacity but normal coronary angiogram (syndrome X). European heart journal 1989; 10(6): 509-513.
97. Kaski JC. Cardiac syndrome X in women: the role of oestrogen deficiency. Heart 2006; 92(Suppl 3): iii5-9.
98. Rosano GM, Collins P, Kaski JC, Lindsay DC, Sarrel PM, Poole-Wilson PA. Syndrome X in women is associated with oestrogen deficiency. European heart journal 1995; 16(5): 610-614.
99. Botker HE, Frobert O, Moller N, Christiansen E, Schmitz O, Bagger JP. Insulin resistance in cardiac syndrome X and variant angina: influence of physical capacity and circulating lipids. American heart journal 1997; 134(2 Pt 1): 229-237.
100. Gaspardone A, Ferri C, Crea F, Versaci F, Tomai F, Santucci A etal. Enhanced activity of sodium-lithium countertransport in patients with cardiac syndrome X: a potential link between cardiac and metabolic syndrome X. Journal of the American College of Cardiology 1998; 32(7): 2031-2034.
101. Koren W, Koldanov R, Peleg E, Rabinowitz B, Rosenthal T. Enhanced red cell sodium-hydrogen exchange in microvascular angina. European heart journal 1997; 18(8): 1296-1299.
102. Ferri C, Desideri G, de Mattia G, Bellini C, Gentile M, Gioffre P etal. Decreased activity of the red blood cell ATPase-dependent Na+ pump in patients with cardiac syndrome X. Clinical science 1999; 97(3): 369-375.
103. Botker HE, Sonne HS, Frobert O, Andreasen F. Enhanced exercise-induced hyperkalemia in patients with syndrome X. Journal of the American College of Cardiology 1999; 33(4): 1056-1061.
104. Botker HE, Sonne HS, Bagger JP, Nielsen TT. Impact of impaired coronary flow reserve and insulin resistance on myocardial energy metabolism in patients with syndrome X. The American journal of cardiology 1997; 79(12): 1615-1622.
105. Antonios TF, Kaski JC, Hasan KM, Brown SJ, Singer DR. Rarefaction of skin capillaries in patients with anginal chest pain and normal coronary arteriograms. European heart journal 2001; 22(13): 1144-1148.
106. Ong P, Sivanathan R, Borgulya G, Bizrah M, Iqbal Y, Andoh J etal. Obesity, inflammation and brachial artery flow-mediated dilatation: therapeutic targets in patients with microvascular angina (cardiac syndrome x). Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy 2012; 26(3): 239-244.
107. Naidu OA, Rajasekhar D, Latheef SA. Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease. Cardiovascular ultrasound 2011; 9: 40.
108. Kidawa M, Krzeminska-Pakula M, Peruga JZ, Kasprzak JD. Arterial dysfunction in syndrome X: results of arterial reactivity and pulse wave propagation tests. Heart 2003; 89(4): 422-426.
109. Cannon RO, 3rd, Quyyumi AA, Schenke WH, Fananapazir L, Tucker EE, Gaughan AM etal. Abnormal cardiac sensitivity in patients with chest pain and normal coronary arteries. Journal of the American College of Cardiology 1990; 16(6): 1359-1366.
110. Pasceri V, Lanza GA, Buffon A, Montenero AS, Crea F, Maseri A. Role of abnormal pain sensitivity and behavioral factors in determining chest pain in syndrome X. Journal of the American College of Cardiology 1998; 31(1): 62-66.
111. Chauhan A, Mullins PA, Thuraisingham SI, Taylor G, Petch MC, Schofield PM. Abnormal cardiac pain perception in syndrome X. Journal of the American College of Cardiology 1994; 24(2): 329-335.
112. Valeriani M, Sestito A, Le Pera D, De Armas L, Infusino F, Maiese T etal. Abnormal cortical pain processing in patients with cardiac syndrome X. European heart journal 2005; 26(10): 975-982.
113. Rosen SD, Paulesu E, Wise RJ, Camici PG. Central neural contribution to the perception of chest pain in cardiac syndrome X. Heart 2002; 87(6): 513-519.