Origin of and therapeutic approach to cardiac syndrome X:Results of the proton pump inhibitor therapy for angina-like lingering pain trial (PITFALL trial)

AIM: To investigate the frequency of gastroen-terological diseases in the etiology and the efficacy of proton pump inhibitors (PPIs) in the treatment of cardiac syndrome X (CSX) as a subform of non-cardiac chest pain (NCCP). METHODS: We investigated 114 patients with CSX using symptom questionnaires. A subgroup of these patients were investigated regarding upper gastrointestinal disorders (GIs) and treated with PPI. Patients not willing to participate in investigation and treatment served as control group. RESULTS: Thirty-six patients denied any residual symptoms and were not further evaluated. After informed consent in 27 of the remaining 78 patients, we determined the prevalence of disorders of the upper GI tract and quantifi ed the effect of treatment with pantoprazole. We found a high prevalence of gastroenterological pathologies (26/27 patients, 97%)with gastritis, gastroesophageal reflux disease (GERD) and acid reflux as the most common associated disorders. If treated according to the study protocol, these patients showed a significant improvement in the symptom score. Patients treated by primary care physicians, not according to the study protocol had a minor response to treatment (n = 19, -43%), while patients not treated at all (n = 26) had no improvement of symptoms (-0%). CONCLUSION: Disorders of the upper GI tract are a frequent origin of CSX in a German population and can be treated with pantoprazole if given for a longer period.

Helicobacter pylori infection and susceptibility to cardiac syndrome X:A systematic review and meta-analysis

BACKGROUND Cardiac syndrome X(CSX)is characterized by persistent angina with normal coronary arteries.Several pathophysiologic mechanisms have been introduced,particularly Helicobacter pylori(H.pylori)infection.AIM To investigate the association between H.pylori infection and CSX.METHODS All studies related to H.pylori infection and CSX were evaluated by comprehensive searches of global databases such as ISI Web of Knowledge,PubMed,Scopus,EMBASE,and Google scholar.Statistical analyses of selected articles were evaluated based on the summary odds ratio(OR).Finally,heterogeneity and publication bias were estimated using the I2 statistic and Cochrane Q-test as well as Begg’s and Egger’s tests.RESULTS A total of 11 studies met our inclusion criteria and 1435 patients(63%female,and 37%male)were reviewed.A significant association was observed between female patients and this syndrome(P=0.02).Our results showed a positive association between infection with this pathogen and presence of CSX(OR:5.65;95%confidence interval[CI]:4.17-7.64;I2:82.20).However,no significant association was observed with cagA-positive H. pylori strains and this syndrome (OR: 0.97;0.56-1.70 with 95%CI). Given the heterogeneity and publication bias, the resultsneed to confirmed by further prospective investigation.CONCLUSIONBased on our results, H. pylori infection is associated with an increased risk ofCSX. This bacterium appears to play a major role in the pathogenesis of CXS byinducing persistent inflammation.

Tongxinluo Capsule(通心络胶囊)for Cardiac Syndrome X：A Systematic Review and Meta-Analysis

Objective： To evaluate the efficacy and safety of Tongxinluo Capsule（通心络胶囊, TXL） for patients with cardiac syndrome X（CSX）. Methods： Randomized controlled trials（RCTs） regarding TXL in the treatment of CSX were searched in Chinese Biomedicine Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Database, Pub Med, EMBASE, Cochrane Central Register of Controlled Trial, websites of the Chinese and International Clinical Trial Registry platform up to June 30, 2015. The intervention was either TXL alone or TXL combined with conventional treatment, while the control intervention was conventional treatment with or without placebo. Data extraction, methodological quality assessment and data analyses were performed according to the Cochrane criteria. The primary outcome was a composite event of death, acute myocardial infarction（AMI）, angina requiring hospitalization, revascularization, and heart failure. The secondary outcome measures were angina symptom improvement, electrocardiograph（ECG） improvement, and serum endothelin-1（ET-1） level. The adverse events were also recorded. RevMan 5.3 software was applied for data analyses. Results： Twelve RCTs（696 patients） were included. Compared with conventional treatment, the addition of TXL to conventional treatment showed some benefits on relieving angina symptoms [risk ratio（RR）： 1.46, 95% confidence interval（CI）（1.25, 1.71）, P〈0.01], and improving ECG [RR： 1.45, 95% CI（1.21, 1.74）, P〈0.01]. The pooled result did not support a benefit of TXL on reducing the incidence of primary outcome [RR： 0.20, 95% CI（0.02, 1.61）, P=0.13]. In addition, TXL decreased serum ET-1 concentration of CSX patients [standardized mean number： –1.63, 95% CI（–2.29, –0.96）, P〈0.01]. No serious adverse events were reported. Conclusions： TXL documents potential benefits on attenuating angina symptoms, improving ECG and decreasing serum ET-1 level for CSX patients. However, more rigorous RCTs with high quality are needed to confirm its efficacy and safety.

Summary of 32 Patients with Cardiac Syndrome X Treated by TCM Therapy of Regulating Qi Relieving Chest Stuffiness and Promoting Blood Circulation

Objective： To evaluate the clinical effect of Liqi Kuanxiong Huoxue method （宽胸活血,LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circulation） in treating patients with cardiac syndrome X （CSX）. Methods： The prospective, non-randomized controlled study was conducted on 51 selected patients with CSX, who were non-randomly assigned to 2 groups, the treated group treated with LKH in addition to the conventional treatment （32 patients）, and the control group treated with conventional treatment （19 patients） like nitrate, diltiazem hydrochloride, etc. The treatment course was 14 days. The changes of such symptoms as angina pectoris, TCM syndrome and indexes of treadmill exercise test before and after treatment were observed. Results： After treatment, such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group （P〈0.05）; the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group （P〈0.05）. The treadmill exercise test showed that the maximal metabolic equivalent （Max MET）, the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups, but the improvement in the treated group was better than that in the control group respectively （P〈0.05）. Conclusion： The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX.

Therapeutic efficacy observation on auricular point sticking therapy for cardiac syndrome X in women

Objective:To observe the clinical effect of auricular point sticking therapy for cardiac syndrome X(CSX)in women.Methods:A total of 64 patients were randomized into two groups by the random number table,with 32 cases in each group.Patients in the control group received conventional treatment for angina,while patients in the treatment group received auricular point sticking therapy on the basis of conventional treatment.After 8 weeks of treatment,the levels of serum estradiol(E2),nitric oxide(NO)and endothelium-1(ET-1)were compared to evaluate the therapeutic effect.Results:After 8 weeks of treatment,the total effective rate and markedly effective rate in the treatment group were significantly higher than those in the control group,and the between-group comparisons showed statistical significance(both P<0.05).After treatment,the scores of chest pain and tightness in the control group dropped significantly,and the intra-group comparisons showed statistical significance(both P<0.05);the scores of chest pain and tightness,palpitations,weakness and shortness of breath in the treatment group dropped significantly,and the intra-group comparisons showed statistical significance(all P<0.05);there were significant inter-group differences in the scores of chest pain and tightness.After treatment,the intra-group comparisons of E2,NO and ET-1 contents in the control group showed no statistical significance(all P>0.05),while the E2,NO and ET-1 contents in the treatment group changed significantly after treatment and were significantly different from those in the control group(all P<0.05).Conclusion:Auricular point sticking on the basis of conventional treatment was effective for CSX in women,and is worth clinical application.

Contemporary Treatment of Western and Chinese Medicine for Cardiac Syndrome X

Clinical reports on cardiac syndrome X（CSX） have been increasing in recent years.In general, CSX does not increase the cardiovascular mortality,but it can affect the patient＇s quality of life（QOL） and increase the incidence rates of cardiovascular and cerebrovascular events.Although a variety of drugs and therapies have been utilized in the clinical treatment,the management of CSX still represents a major challenge due to its unclear pathogenesis.It is necessary to explore more effective treatment programs.Many attempts have been made on trials of the Chinese medicine（CM） treatment for CSX and proved that CM has a certain advantage in efficacy to improve clinical symptoms and QOL.CM may provide a new approach for the effective treatment of CSX.

Inflammation:an important mechanism for different clinical entities of coronary artery diseases

AIthough atherosclerosis has been considered to be multi-factorial disease in which genetic,environmental, metabolic factors have been implicated, the gaps remain in our knowledge of the etiopathogenesis of atherosclerosis. There is mounting evidence that inflammation plays an important role in the initiation, development as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease. Although triggers and pathways of inflammation are probably multiple and different in different clinical settings, the data from animals as well as humans including our groups indicated that an inflammatory process was involved in all stages of atherosclerosis appeared in different clinical entities.