A significant number of patients with cardiac syndrome X(CSX) present frequent episodes of severe chest pain, refractory to maximal multi-drug therapy. A few, small, uncontrolled data suggested that spinal cord stimul...A significant number of patients with cardiac syndrome X(CSX) present frequent episodes of severe chest pain, refractory to maximal multi-drug therapy. A few, small, uncontrolled data suggested that spinal cord stimulation(SCS) may have favourable clinical benefits in these patients. Methods and results: We studied 10 CSX patients who were being treated by SCS for refractory angina pectoris for 17± 16 months(median 8). Patients were randomized to either continue or withdraw SCS for a period of 3 weeks and were then crossed over to the other condition for a further 3- week period. During each 3- week period patients kept a detailed diary of angina episodes occurring in the last 2 weeks of each phase. Furthermore, at the end of each 3- week period, angina status was also assessed by Seattle Angina Questionnaire(SAQ), a 0- 100 visual analogue scale(VAS), and patients underwent 24- h Holter monitoring(HM) and echocardiographic dobutamine stress test(DST). Compared with the withdrawal phase, SCS reduced the number(P=0.01), duration(P=0.022), and severity(P=0.011) of angina episodes, and nitrate consumption(P=0.042). SAQ scores(P≤ 0.013 for all) and VAS(P< 0.001) were also improved, the number of episodes of ST-segment depression on HM was decreased(P=0.014), and time to angina(P=0.045) and to 1 mm ST-segment depression(P=0.04) during DST were both prolonged by SCS. Conclusions: Our data point out that SCS may be an effective form of treatment in patients with CSX suffering from frequent angina episodes significantly impairing quality of life(QOL) and refractory to maximally tolerated drug therapy.展开更多
Previous studies suggested that an enhanced pain sensitivity is present in patients with cardiac syndrome X(SX). We investigated whether SX patients present abnormalities in the electrical cerebral signals generated b...Previous studies suggested that an enhanced pain sensitivity is present in patients with cardiac syndrome X(SX). We investigated whether SX patients present abnormalities in the electrical cerebral signals generated by pain stimuli. Methods and results: Cortical laser evoked potentials(LEPs) were recorded in 16 SX patients, in 10 patients with refractory angina due to obstructive coronary artery disease(CAD) and in 13 healthy controls. LEPs were recorded during stimulation of chest and right hand dorsum. Three sequences of painful stimuli were applied at each site. Subjective pain rating was assessed by a 0- 100 mm visual analogic scale(VAS). Basal LEPs did not differ among groups and there were no differences for most LEP components across the repetitions of stimuli. However, the amplitude of the N2/P2 LEP component, specifically reflecting cortical pain processing, decreased across the three sequences of stimuli in controls and CAD patients, but not in SX patients. Compared with the first sequence, the N2/P2 amplitude during the third sequence of stimuli in the three groups was 77± 16, 56± 24, and 99± 34% , respectively, for chest(P=0.001), and 63± 31, 72± 17, and 98± 46% , respectively, for right hand(P=0.03) stimulation. The changes in VAS pain score across the three sequences paralleled those of N2/P2 amplitude. Conclusion: Our data show that in SX patients, central handling of painful stimuli is characterized by inadequate habituation, which might play a role in determining the peculiar clinical characteristics of anginal chest pain of these patients.展开更多
文摘A significant number of patients with cardiac syndrome X(CSX) present frequent episodes of severe chest pain, refractory to maximal multi-drug therapy. A few, small, uncontrolled data suggested that spinal cord stimulation(SCS) may have favourable clinical benefits in these patients. Methods and results: We studied 10 CSX patients who were being treated by SCS for refractory angina pectoris for 17± 16 months(median 8). Patients were randomized to either continue or withdraw SCS for a period of 3 weeks and were then crossed over to the other condition for a further 3- week period. During each 3- week period patients kept a detailed diary of angina episodes occurring in the last 2 weeks of each phase. Furthermore, at the end of each 3- week period, angina status was also assessed by Seattle Angina Questionnaire(SAQ), a 0- 100 visual analogue scale(VAS), and patients underwent 24- h Holter monitoring(HM) and echocardiographic dobutamine stress test(DST). Compared with the withdrawal phase, SCS reduced the number(P=0.01), duration(P=0.022), and severity(P=0.011) of angina episodes, and nitrate consumption(P=0.042). SAQ scores(P≤ 0.013 for all) and VAS(P< 0.001) were also improved, the number of episodes of ST-segment depression on HM was decreased(P=0.014), and time to angina(P=0.045) and to 1 mm ST-segment depression(P=0.04) during DST were both prolonged by SCS. Conclusions: Our data point out that SCS may be an effective form of treatment in patients with CSX suffering from frequent angina episodes significantly impairing quality of life(QOL) and refractory to maximally tolerated drug therapy.
文摘Previous studies suggested that an enhanced pain sensitivity is present in patients with cardiac syndrome X(SX). We investigated whether SX patients present abnormalities in the electrical cerebral signals generated by pain stimuli. Methods and results: Cortical laser evoked potentials(LEPs) were recorded in 16 SX patients, in 10 patients with refractory angina due to obstructive coronary artery disease(CAD) and in 13 healthy controls. LEPs were recorded during stimulation of chest and right hand dorsum. Three sequences of painful stimuli were applied at each site. Subjective pain rating was assessed by a 0- 100 mm visual analogic scale(VAS). Basal LEPs did not differ among groups and there were no differences for most LEP components across the repetitions of stimuli. However, the amplitude of the N2/P2 LEP component, specifically reflecting cortical pain processing, decreased across the three sequences of stimuli in controls and CAD patients, but not in SX patients. Compared with the first sequence, the N2/P2 amplitude during the third sequence of stimuli in the three groups was 77± 16, 56± 24, and 99± 34% , respectively, for chest(P=0.001), and 63± 31, 72± 17, and 98± 46% , respectively, for right hand(P=0.03) stimulation. The changes in VAS pain score across the three sequences paralleled those of N2/P2 amplitude. Conclusion: Our data show that in SX patients, central handling of painful stimuli is characterized by inadequate habituation, which might play a role in determining the peculiar clinical characteristics of anginal chest pain of these patients.
