Comparative studies on hemodynamics coronary circulation myocardial energy metabolism and catecholamine flux before and during exercise in patients with syndrome x hypertensive heart disease and obstructive coronary artery disease

Ishihara, T.

Journal of Osaka Medical College 44(1): 236-237


Accession: 004999095

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Obstructive coronary artery disease with effort angina (EA) and myocardial infarction (OMI) can be diagnosed clinically by coronary arteriography (CAG). On the other hand, syndrome X (Sx) is a heart disease with chest pain and ischemic ST change in the ECG but a normal CAG, and hypertensive heart disease (HHD) also has marked ST-T change in the ECG but a normal CAG. It is of prime interest to study the differences of myocardial metabolism and coronary circulation in these clinically similar diseases. In this study, 21 patients with Sx, 20 patients with HHD, 13 patients with EA, 19 patients with OMI and 8 controls (C) were studied by coronary sinus catheterization and measurements of hemodynamics, coronary circulation, myocardial metabolism (glucose, lactate, pyruvate, free fatty acid, creatine, inorganic phosphate and potassium) and coronary arteriovenous differences of catecholamines before and during bicycle ergometry (50 Watt, 50 rpm, 15 minutes). Group C with a lower mean age than the other groups, received exercise tolerance tests and showed a good hemodynamic response and coronary reserve; myocardial matabolism was aerobic under mild adrenergic stimulation. In Sx group, pre-exercise tests were normal, but the increase of coronary blood flow was restricted and myocardial metabolism tended to be anaerobic under hyperdynamic conditions, and ischemic ST changes developed with excessive sympathoadrenergic stimulation. In HHD group, ST-T changes were the most prominent, but the hemodynamic and coronary response, and myocadial metabolism were well preserved with mild adrenergic stimulation. The ECG changes could not be accounted for by myocardial ischemia. In EA group, the hemodynamic and coronary reserve for exercise were limited due to coronary obstructive lesions and myocardial anaerobic metabolism and potassium release, causing ischemic ST changes in the ECG. In OMI group, the coronary circulation and myocardial metabolism were well preserved in the surviving parts of the myocardium, but the hemodynamic reserve for exercise was limited because of the absolute decrease of functioning myocardium.