Impaired left ventricular filling dynamics in patients with angina and angiographically normal coronary arteries: effect of beta adrenergic blockade.

Fragasso, Gabriele; Chierchia, Sergio; Pizzetti, Giuseppe; Rossetti, E.; Carlino, Mauro; Gerosa, Stefano; Carandente, O; Fedele, Anna Laura; Cattaneo, N

doi:10.1136/hrt.77.1.32

Cited by 44 publications

(19 citation statements)

References 43 publications

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“…Fragasso et al [11] demonstrated that atenolol significantly reduced episodes of angina and completely prevented exercise-induced ST segment changes in 18 of 22 patients with syndrome X. Other investigators obtained similar results with propranolol [12,13].…”

Section: Beta-blocker Therapymentioning

confidence: 81%

Syndrome X

Suwaidi

Lerman

2000

Curr Treat Options Cardio Med

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Syndrome X, defined as typical angina with positive exercise test results and normal coronary angiographic findings, represents a multifactorial pathophysiologic state that may range from abnormalities in pain perception to abnormalities in endothelial- and nonendothelial-dependent coronary flow reserve associated with myocardial ischemia. Treatment begins with accurate diagnosis by means of a comprehensive coronary vascular reactivity evaluation. This may lay the groundwork for appropriate treatment. The management of patients with syndrome X is challenging, and it may be necessary to attempt various medications depending on the patient's response. We feel that the first step in the treatment is accurate diagnosis. This is done by performing a functional angiogram (assessment of endothelial-dependent and endothelial-independent coronary flow reserve). In those without evidence of coronary flow reserve abnormalities, reassurance might be curative; however, in those who continue to have symptoms, a trial of imipramine therapy at a dose of 50 mg/d may be attempted, provided other organic disorders (in particular gastrointestinal disorders) are excluded. Those who demonstrate evidence of abnormal coronary vascular reactivity are approached as outlined in Figure 1. Patients are advised to avoid medications that may cause coronary "spasm." We routinely refer our patients to the cardiovascular health clinic for risk factor management and an exercise program. Our first choice of medications usually consists of slow-release calcium channel blockers. We tend to start with a once-a-day regimen, and based on the response, we occasionally change the regimen to twice a day. If the functional angiogram reveals concomitant epicardial disease, then nitrates are added to the medical regimen. Angiotensin-converting enzyme inhibitors are part of the treatment if the patient has hypertension or diabetes or if calcium channel blocker therapy fails. l-Arginine at an initial dosage of 1 g three times daily is added and may be increased to 3 g three times daily if no contraindications are present. Because there are no data regarding the effect of l-arginine, which may affect insulin secretion, in patients with diabetes, we use caution in this patient population. There is no "gold standard" therapy for syndrome X, so each patient may respond differently to the initial medical therapy. Thus, we follow these patients closely to monitor their response to treatment.

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Section: Beta-blocker Therapymentioning

confidence: 81%

Syndrome X

Suwaidi

Lerman

2000

Curr Treat Options Cardio Med

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“…The study also demonstrated favorable effects on ST-segment changes during an exercise stress test. Fragasso et al [53] also showed in a randomized, crossover trial of 22 patients with Syndrome X that atenolol increased exercise tolerance, improved left ventricular filling indices, and prevented exercise-induced STsegment changes. Atenolol likely works by ␤-blockade of abnormally increased adrenergic tone.…”

Section: ␤-Blockersmentioning

confidence: 92%

Recent developments in microvascular angina

Farouk

Smart

Nguyen

et al. 2001

Curr Atheroscler Rep

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Microvascular angina (Syndrome X) is an extremely heterogeneous clinical entity that is the product of genetic, coronary microvascular, metabolic, and clinical factors, which combine together to produce distinct cardiac manifestations and complications. The interactions of these abnormalities remain poorly understood. The diagnosis is considered in patients with anginal symptoms and no epicardial coronary narrowing. Therapy is also problematic, with beta-blockers as first-line pharmacotherapy followed by angiotensin-converting enzyme inhibitors and calcium channel blockers.

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“…This vasodilatory action depends on its potentiating effect on the bioactivity and levels of nitric oxide (13,14). An apparent effect of conventional beta-blockers on endothelial dysfunction has not been demonstrated (15). There is no study in the literature that investigated how nebivolol affects endothelial dysfunction in patients diagnosed with BD.…”

Section: Introductionmentioning

confidence: 94%

Effect of nebivolol on endothelial dysfunction in patients with Behçet’s disease; a prospective single-arm controlled study

Akkaya¹,

Şahin²,

Borlu³

et al. 2012

Anadolu Kardiyol Derg

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Objective: Behçet's disease (BD) is a systemic vasculitis, capable of involving all types of vessels. Endothelial dysfunction (ED) has been previously documented in BD. Previous studies showed that nebivolol might improve endothelial functions in endothelial dysfunction. The aim of our study is to assess the effects of nebivolol on endothelial dysfunction in patients with Behçet's disease. Methods: This study was designed as prospective single-arm controlled study. We prospectively studied 35 Behçet's patients who were diagnosed according to the International Study Group criteria. Patients received 5 mg nebivolol per day for 3 months. Endothelial dysfunction was evaluated by brachial artery flow-mediated dilatation (FMD) method using high-resolution vascular ultrasound device at baseline and after for 3-month therapy. The paired samples t test, Wilcoxon test, Pearson, Spearman correlation analyses were used for statistical analysis. Results: A significant improvement was observed in FMD after therapy period (4.23±1.19 vs 7.95±2.21%, p<0.001). The correlation analysis showed a negative correlation between post-treatment high-sensitive C-reactive protein and FMD (r=-0.435, p=0.009). No adverse effects were observed in treatment period. Conclusion: Nebivolol improved endothelial dysfunction in Behçet's patients. However, further comprehensive studies are needed to determine the long-term effects of nebivolol. (Anadolu Kardiyol Derg 2013; 13: 115-20

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Impaired left ventricular filling dynamics in patients with angina and angiographically normal coronary arteries: effect of beta adrenergic blockade.

Cited by 44 publications

References 43 publications

Syndrome X

Syndrome X

Recent developments in microvascular angina

Effect of nebivolol on endothelial dysfunction in patients with Behçet’s disease; a prospective single-arm controlled study

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