BACKGROUND: Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. In this study, we investigate the impact of MBSR on left ventricular (LV) and endothelial function in female patients with microvascular angina. METHODS: A total of 34 female patients (mean age 52.2 ± 13.8 years) diagnosed with microvascular angina underwent a MBSR program with anti-anginal medication for 8 weeks. The global longitudinal strain (GLS) of the LV was used as a parameter to assess myocardial function and reactive brachial flow-mediated dilatation (FMD) was used to assess endothelial function. Symptoms were analyzed by the Symptom Checklist 90 Revised to determine emotional stress. Changes in GLS and FMD between baseline and post-MBSR were analyzed. RESULTS: After 8 weeks of programmed MBSR treatment, stress parameters were significantly decreased. In addition, GLS (−19.5 ± 2.1% vs. −16.6 ± 2.5%, p < 0.001) and reactive FMD significantly improved (8.9 ± 3.0% vs. 6.9 ± 2.6%, p = 0.005) after MBSR compared to baseline. The changes in GLS correlated to changes in FMD (r = 0.120, p = 0.340) and with the changes in most stress parameters. CONCLUSION: MBSR has beneficial impacts on myocardial and endothelial function in female patients with microvascular angina.
Checklist ; Dilatation ; Female* ; Humans ; Meditation ; Microvascular Angina* ; Mindfulness* ; Stress, Psychological

Coronary Circulation ; Coronary Vessels/diagnostic imaging* ; Humans ; Microcirculation ; Microvascular Angina

Single coronary artery (SCA) is a rare congenital anomaly and commonly associated with other congenital cardiac malformations. Some subgroups of SCA can lead to angina pectoris, acute myocardial infarction, or even sudden cardiac death in the absence of atherosclerosis. An anomalous origin of the right coronary artery, arising from the distal portion of the left circumflex artery, has previously been reported in a few cases. In this article, we report a case of a right coronary artery arising from the distal portion of the left circumflex artery with no other cardiac congenital anomaly.
Angina Pectoris ; Arteries ; Atherosclerosis ; Coronary Vessels ; Death, Sudden, Cardiac ; Microvascular Angina ; Myocardial Infarction

PURPOSE: The triad of chest pain, normal coronary arteries and a positive stress test has been called microvascular angina. The link between coronary flow reserve(CFR) and Duke treadmill score(DTS) in patients with microvascular angina remains elusive. METHODS: We studied 108 subjects (M:F=8:60, mean age 54+/-9 yrs) with chest pain and normal coronary angiogram. Exercise treadmill test(ETT) was performed by Bruces protocol and the equation for calculating DTS was DTS=xercise time- (5xST deviation)-(4x exercise angina), with 0=one, 1=onlimiting, 2=exercise-limiting. The coronary flow velocity at diastole(PDV) using Transesophageal echocardiography (TEE) was obtained from the proximal left anterior descending coronary artery and coronary flow reserve(CFR) was calculated as the ratio of hyperemic PDV after the intravenous infusion of dipyridamole(0.56 mg/kg) to baseline PDV. RESULTS: 1) CFR was 3.04+/-0.45 in group with negative ETT and 2.19+/-0.62 in group with positive ETT(p<0.001). 2) CFR was 1.51+/-0.31 in high-risk group with a score of <-10, 2.39+/-0.63 in moderate-risk group with scores from -10 to + and 3.04+/-0.43 in low-risk group with a score of > or =+ on DTS(p< 0.001 versus low-risk, respectively). 3) DTS was significantly related to CFR (r=.704, p<0.001). CONCLUSION: The composite DTS is closely related to CFR using TEE and might be a useful tool that can help clinicians determine the severity of ischemia and evaluate the efficacy of treatment in patients with microvascular angina.
Chest Pain ; Coronary Vessels ; Echocardiography, Transesophageal* ; Exercise Test ; Humans ; Infusions, Intravenous ; Ischemia ; Microvascular Angina*

A single coronary artery (SCA) is a rare congenital anomaly, which is often associated with myocardial ischemia. We report a SCA consisting of an anomalous right coronary artery originating from the distal left circumflex artery diagnosed by coronary angiography and multidetector computed tomography angiography.
Angiography ; Arteries ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels ; Microvascular Angina ; Multidetector Computed Tomography ; Myocardial Ischemia

Angioplasty, Balloon, Coronary ; Coronary Artery Disease ; etiology ; Coronary Disease ; etiology ; Humans ; Inflammation ; complications ; Microvascular Angina ; etiology ; Myocardial Ischemia ; etiology

BACKGROUND AND OBJECTIVES: Previous studies suggest the endothelium dependent coronary vasodilation is impaired in many patients with microvascular angina. However, the relationship between the peripheral vascular endothelial function and coronary flow reserve (CFR) in these patients remains elusive. The relationship between the peripheral vascular endothelial function and CFR was sought in patients with chest pain and a normal coronary angiogram. SUBJECTS AND METHODS: In 32 subjects (mean age 58+/-9 yrs, M:F=9:23) with chest pain and a normal coronary angiogram, the flow mediated dilation (FMD) was assessed in the brachial artery by measuring the change in brachial artery diameter in response to hyperemic flow. In all subjects, the intimamedia thickness (IMT) of the carotid artery was also measured using a 15 MHz linear array transducer. Subjects were divided into 2 groups according to their CFR:> or =2.1 or<2.1, as measured with transthoracic echocardiography in the distal left anterior descending coronary artery. RESULTS: The percentage FMD was 6.04+/-5.78% in those with a CFR<2.1 and 11.77+/-6.82% in those with a CFR> or =2.1 (p<0.05). The CFR was closely related to the peripheral FMD (r=0.361, p<0.05). The average IMT were 0.71+/-0.26 and 0.68+/-0.14 mm in those with CFR<2.1 and > or =2.1 (p=NS), respectively. The percentage FMD was not related to the IMT (p=NS). CONCLUSION: Microvascular dysfunction is primarily related to endothelial dysfunction, rather than advanced atherosclerosis, and this endothelial dysfunction is a generalized process that involves whole arteries in patients with chest pain and a normal coronary angiogram.
Arteries ; Atherosclerosis ; Brachial Artery ; Carotid Arteries ; Chest Pain* ; Coronary Vessels ; Echocardiography ; Endothelium ; Endothelium, Vascular ; Humans ; Microvascular Angina ; Thorax* ; Transducers ; Vasodilation

BACKGROUNDThe purpose of this study was to assess the morphological changes and physiological function of coronary arteries in patients presenting with chest pain but having normal coronary angiograms, using intravascular ultrasound imaging (IVUS) and intracoronary Doppler (ICD) flow measurements, in order to elucidate the mechanism of syndrome X.

METHODSA total of 126 patients [67 males, 59 females, mean age (53.1 +/- 13.0) years] who experienced chest pain but had normal coronary angiograms were included in this study. ICD flow measurements of the left anterior descending coronary artery (LAD) were performed using a Cardiometrics FloMap II system. Coronary flow velocity reserve (CFVR) was defined as the ratio of the average peak velocity during hyperemia to that at baseline, induced by an intracoronary bolus injection of 18 microg adenosine. A 3.2F or 2.9 F 30 MHz mechanical rotating ultrasound catheter (CVIS, Boston Scientific) or a 3.0 F 20 MHz electronic ultrasound catheter (Endosonics) was used for IVUS.

RESULTSThe mean CFVR value of the LAD was 2.71 +/- 0.74. Reduction of CFVR (< 3.0) was found in 82 of 126 (65.1%) patients. IVUS images of the LAD were available for 109 patients. Plaque formation was detected in 76/109 (69.7%) patients. Based on the presence or absence of plaque formation as well as the reduction or non-reduction of CFVR, patients were divided into four groups: Group I (n = 10), normal IVUS findings and normal CFVR; Group II (n = 23), normal IVUS findings with reduction in CFVR; Group III (n = 29), IVUS evidence of plaque formation but normal CFVR; and Group IV (n = 47), IVUS evidence of plaque formation with reduction in CFVR.

CONCLUSIONThis study shows the important clinical value of a combination of IVUS and ICD in diagnosing patients with angiographically normal coronary arteries. Only 10% of patients studied (Group I) were found to be truly free of coronary disease, while 20% of patients (Group II) would be diagnosed as suffering from syndrome X.

Adult ; Aged ; Coronary Angiography ; Coronary Circulation ; Female ; Humans ; Laser-Doppler Flowmetry ; Male ; Microvascular Angina ; diagnosis ; physiopathology ; Middle Aged ; Ultrasonography, Interventional

The active ingredients of Ficus hirta and Hypericum perforatum were collected from Traditional Chinese Medicine Database and Analysis Platform(TCMSP) and related papers. The potential targets of these two medicinal herbs were searched from HERB database, and those associated with microvascular angina were screened out from GeneCards, Online Mendelian Inheritance in Man(OMIM), Therapeutic Target Database(TTD), and HERB. Cytoscape was used to construct a protein-protein interaction(PPI) network of the common targets shared by the two herbs and microvascular angina based on the data of String platform. Metascape was employed to identify the involved biological processes and pathways enriched with the common targets. Cytoscape was used to draw the "active ingredient-target-pathway" network. AutoDock Vina was used to dock the core ingredients with the key targets. A total of 19 potential active ingredients and 71 potential targets were identified to be associated with microvascular angina. Bioinformatics analysis showed that phosphatidylinositol-3-kinase/protein kinase B(PI3 K-AKT), interleukin-17(IL17), hypoxia-inducible factor 1(HIF-1) and other signaling pathways were related to the treatment of microvascular angina by F. hirta and H. perforatum. Molecular docking results showed that β-sitosterol, luteolin and other ingredients had strong affinity with multiple targets including mitogen-associated protein kinase 1(MAPK1), epidermal growth factor receptor(EGFR) and so on. These findings indicated that F. hirta and H. perforatum may regulate PI3 K-AKT, IL17, HIF-1 and other signaling pathways by acting on multiple targets to alleviate oxidative stress, inhibit inflammatory response, regulate angiogenesis, and improve vascular endothelium and other functions. This study provides reference for in vitro and in vivo studies of the treatment of microvascular angina.
Drugs, Chinese Herbal/pharmacology* ; Ficus ; Humans ; Hypericum ; Medicine, Chinese Traditional ; Microvascular Angina ; Molecular Docking Simulation ; Network Pharmacology

This study reviewed the current status of the use of outcome indicators in randomized controlled trial(RCT) on traditional Chinese medicine(TCM) treatment of microvascular angina(MVA) and analyzed the existing problems and possible solutions, aiming to provide a basis for the design of high-quality RCT and the establishment of core outcome sets for MVA. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, Web of Science, and 2 clinical trial registries were searched for the RCT on TCM treatment of MVA according to pre-defined criteria. The Cochrane's risk of bias assessment tool was used to evaluate the methodological quality of the included RCT and the use of outcome indicators was summarized. A total of 69 RCTs were included, from which 100 outcome indicators were extracted, with the frequency of 430. The extracted outcome indicators belonged to 8 domains: response rate, symptoms and signs, physical and chemical examinations, TCM efficacy, safety, quality of life, economic evaluation, and long-term prognosis. The indicators of physical and chemical examinations were the most(70 indicators with the frequency of 211), followed by those of response rate(7 indicators with the frequency of 73) and symptoms and signs(7 indicators with the frequency of 54). The outcome indicators with higher frequency were adverse reactions, angina attack frequency, clinical efficacy, endothelin-1, total duration of treadmill exercise, and hypersensitive C-reactive protein. The RCT on TCM treatment of MVA had the following problems: irregular reporting of adverse reactions, diverse indicators with low frequency, lack of attention to the application of endpoint indicators, insufficient use of TCM differentiation and efficacy indicators, non-standard evaluation criteria and failure to reflect the basic characteristics of TCM. A unified MVA syndrome differentiation standard should be established, on the basis of which an MVA treatment efficacy evaluation system and core outcome indicator set that highlights the characteristics of TCM with patient-reported outcomes as the starting point should be established to improve the clinical research and research value.
Humans ; Medicine, Chinese Traditional ; Drugs, Chinese Herbal/adverse effects* ; Microvascular Angina/drug therapy* ; Quality of Life ; Phytotherapy ; Treatment Outcome