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OBJECTIVES: The goal of this study was to test the hypothesis that an abnormal response to beta-adrenergic stimulation may play a role in the pathophysiology of chest pain in patients with normal coronary arteries. BACKGROUND: The mechanism of angina-like(AL)chest pain in patients with angiographically normal coron ary arteries remains controversial. METHODS: Fifty-eight patients with AL pain and a normal coronary angiogram underwent dobutamine echocardiography(DE)to evaluate regional wall motion and intraventricular flow velocities(IFV). Control patients consisted of 22 matched patients free of angina and coronary artery disease. Abnormal IFV were defined as dagger-shaped Doppler spectrum ≥3 m/s. RESULTS : Dobutamine-induced regional wall motion abnormalities did not develop in any of the patients. An IFV ≥3 m/s was found in 28 patients(48%)with AL pain but i n only 4(18%)control patients(p< 0.05). In the subgroup of patients with AL pai n and IFV ≥3 m/s, plasma renin concentration(PRC)was higher as compared with th ose with IFV< 3 m/s(18±17 pg/ml vs. 9±6 pg/ml, p< 0.05). There were no differe nces in plasma ADR, NADR, or angiotensin-converting enzyme levels. Fourteen pat ients with angina and IFV ≥3 underwent control DE and blood sampling after 6 we eks treatment with 10 mg of bisoprolol. In these patients, a decrease in IFV(fro m 3.4±0.35 m/s to 2.46±0.64 m/s, p< 0.001)and a decrease in angina score(from 5.4±1.5 to 0.6±1.4, p< 0.001)were observed at follow-up. CONCLUSIONS: The pre sent data suggest that an exaggerated myocardial response to beta-adrenergic st imulation plays a role in the mechanisms of chest pain in some patients with nor mal coronary arteries.
OBJECTIVES: The goal of this study was to test the hypothesis that an abnormal response to beta-adrenergic stimulation may play a role in the pathophysiology of chest pain in patients with normal coronary arteries. The mechanism of angina-like (AL) chest pain in patients with angiographically normal coron ary arteries remains controversial. METHODS: Fifty-eight patients with AL pain and a normal coronary angiogram underwent dobutamine echocardiography (DE) to evaluate regional wall motion and intraventricular flow velocities (IFV). matched patients free of angina and coronary artery disease. Abnormal IFV were defined as dagger-shaped Doppler spectrum ≥ 3 m / s. RESULTS: Dobutamine-induced regional wall motion abnormalities did not develop in any of the patients. s was found in 28 patients (48%) with AL pain but only 4 (18%) control patients (p <0.05). In the subgroup of patients with AL pai n and IFV ≥ 3 m / s, plasma renin concentrat ion (PRC) was higher as compared with IFO <3 m / s (18 ± 17 pg / ml vs. 9 ± 6 pg / ml, p <0.05) There were no differeces in plasma ADR, NADR, Fourteen patients with angina and IFV ≥ 3 underwent control DE and blood sampling after 6 we eks treatment with 10 mg of bisoprolol. In these patients, a decrease in IFV (fro m 3.4 ± 0.35 m / s to 2.46 ± 0.64 m / s, p <0.001) and a decrease in angina score (from 5.4 ± 1.5 to 0.6 ± 1.4, p <0.001) were observed at follow-up. CONCLUSIONS: The pre sent data suggest that an exaggerated myocardial response to beta-adrenergic st imulation plays a role in the mechanisms of chest pain in some patients with nor mal coronary arteries.