Coronary vasodilator reserve, pain perception, and sex in patients with syndrome X

Background: It remains unclear whether myocardial ischemia due to coronary microvascular dysfunction is the cause of chest pain in syndrome X (chest pain, ischemic-like stress ECG despite angiographically normal coronary arteries). To assess the function of the coronary microcirculation and its relation to pain perception, we measured myocardial blood flow (MBF) and coronary vasodilator reserve (CVR) in 29 patients with syndrome X and 20 matched normal control subjects. Methods and Results: MBF at rest and after intravenous dipyridamole (0.56 mg · kg^-1 over 4 minutes) was measured using positron emission tomography with H₂ ¹⁵O. CVR was calculated as MBF(dipyridamole)/MBF(rest). ECG changes and chest pain after dipyridamole in syndrome X were compared with those in 35 patients with coronary artery disease (CAD). Resting and postdipyridamole MBFs were homogeneous throughout the left ventricle in syndrome X patients and control subjects. MBF was 1.05 (0.25), mean (SD) versus 1.00 (0.22) mL · min^-1 · g^-1 (P=NS) at rest and 2.73 (0.81) versus 3.00 (1.00) mL · min^-1 · g^-1 (P=NS) after dipyridamole in patients and control subjects, respectively. CVRs were 2.66 (0.76) and 3.06 (1.08) (P=NS) and after correction of resting MBF for rate- pressure product were 2.35 (0.83) and 2.34 (0.90) (P=NS) in patients and control subjects, respectively. Female syndrome X patients had higher resting MBF than males, at 1.18 (0.20) versus 0.88 (0.19) mL · min^-1 · g^-1 (P