Introduction
Methods
CSX definitions
Impact of CSX definition upon CSX incidence
Results
CSX definitions
Inclusion criteria for CSX | Number of studies |
---|---|
Angina pectoris | 18 |
Positive exercise stress test | |
Normal coronary arteries | |
Effort induced angina pectoris | 17 |
Positive exercise stress test | |
Normal coronary arteries | |
Angina pectoris | 11 |
Positive exercise stress test OR positive SPECT | |
Normal coronary arteries | |
Angina pectoris | 4 |
Normal coronary arteries | |
Angina pectoris | 4 |
Positive exercise stress test AND positive SPECT | |
Normal coronary arteries | |
Angina pectoris | 1 |
Positive exercise stress test | |
No significant CAD on CAG | |
Effort induced AP | 1 |
Positive exercise stress test | |
Normal coronary arteries AND prolonged coronary flow on CAG | |
Angina pectoris | 1 |
Positive exercise stress test | |
Normal coronary arteries AND reduced LVEF on echo | |
Angina pectoris | 1 |
Positive SPECT | |
Normal coronary arteries |
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Out of the 57 studies 42 required positive exercise electrocardiograms for the diagnosis of CSX. The general criterion, when given, for a positive exercise stress test result was uniform ST depression ≥1 mm. Only one study considered stress-induced angina without significant ST depression to be positive for ischaemia [15].
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As much as 11 studies regarded positive myocardial perfusion images to be good alternatives to a positive result from exercise testing.
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As much as 18 studies considered effort-induced angina pectoris as an inclusion criterion.
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Four studies defined CSX simply as angina pectoris and normal CAG, the so-called broad diagnosis of CSX.
Exclusion criteria used in the studies for present review | N studies of 57 total |
---|---|
Valvular heart disease | 33 |
Diabetes mellitus | 32 |
Left ventricular hypertrophy | 26 |
Hypertension | 24 |
Cardiomyopathy (non specified) | 23 |
Renal failure | 22 |
History of myocardial infarction | 15 |
LV dysfunction | 14 |
Coronary spasm | 13 |
Hepatic dysfunction | 12 |
Arrhytmias | 9 |
Inflammatory disease | 9 |
Dyslipidaemia | 8 |
Left bundel branch block | 8 |
Cardiac disease (non specified) | 7 |
Gastro Intestinal disorder | 7 |
Systemic disease (non specified) | 6 |
Smoking | 6 |
Thyroid dysfunction | 5 |
Obesitas | 5 |
Non-cardiac chest pain | 5 |
Condunction disorder (incl LBTB) | 5 (13) |
Hypertrophic CMP (total CMP) | 5 (23) |
Congestive CMP (total CMP) | 5 (23) |
Dilated CMP (CMP total) | 4 (23) |
Alcoholism | 4 |
Metabolic syndrome | 4 |
Dysphagia/oesophagitis | 3 |
Malignancy | 3 |
LVEF < 40% | 2 |
Psychiatric ilness | 2 |
Auto immune disease | 2 |
Estrogen replacement therapy | 2 |
PTCA/CABG in history | 2 |
Ectasia on CAG | 2 |
Bridging on CAG | 2 |
Claudicatio intermittens | 2 |
Heart failure (non specfied) (total) | 1 (17) |
Myocarditis | 1 |
Congenital heart disease | 1 |
Aortic wall diseases | 1 |
Anaemia | 1 |
Thrombocytopenia | 1 |
Included study of CSX patients | Year |
n
| Female (%) | Mean age (Y) |
---|---|---|---|---|
Lee [41] | 2008 | 21 | 81 | 55 |
Timurkaynak [61] | 2008 | 79 | 54 | 50 |
Cemin [11] | 2008 | 11 | 100 | 59 |
Zorc-Pleskovic [66] | 2008 | 31 | 100 | 55 |
Lanza [38] | 2008 | 18 | 61 | 58 |
Altun [2] | 2007 | 9 | 77 | 49 |
Cotrim [12] | 2008 | 91 | 48 | 51 |
Asbury [5] | 2008 | 64 | 100 | 58 |
Demir [18] | 2008 | 17 | 41 | 57 |
Grabczewska [23] | 2007 | 53 | 57 | 55 |
Li [44] | 2007 | 36 | 100 | NA |
Okyay [48] | 2007 | 32 | 66 | 53 |
Dabek [15] | 2007 | 34 | 65 | 57 |
Yildiz [64] | 2007 | 10 | 79 | 49 |
Kayikcioglu [33] | 2007 | 30 | 60 | 46 |
Mao [45] | 2007 | 51 | 78 | 21 |
Dabek [14] | 2007 | 36 | 65 | 57 |
Vermeltfoort [63] | 2007 | 20 | 75 | 55 |
Galiuto [21] | 2007 | 17 | 53 | 55 |
Alroy [1] | 2007 | 42 | 100 | 52 |
Huang [29] | 2007 | 12 | 60 | 63 |
Guzik [28] | 2007 | 43 | 65 | 44 |
Gur [26] | 2007 | 23 | 70 | 49 |
Gur [27] | 2007 | 23 | NA | NA |
Sgueglia [59] | 2007 | 30 | 73 | 61 |
Russell [55] | 2007 | 24 | 89 | 54 |
Sen [56] | 2007 | 203 | 58 | 53 |
Shmilovich [60] | 2007 | 17 | 71 | 58 |
de Vries [17] | 2006 | 42 | 26 | 58 |
Nam [47] | 2006 | 52 | NA | NA |
Eskandarian [19] | 2006 | 40 | 73 | 46 |
Cay [10] | 2006 | 126 | 62 | 53 |
Jadhav [30] | 2006 | 52 | 100 | 56 |
Czepczynski [13] | 2006 | 68 | 63 | 45 |
Leu [43] | 2006 | 92 | 21 | 64 |
Lanza [40] | 2005 | 10 | 59 | 70 |
Cay [9] | 2005 | 80 | 52 | 51 |
On [49] | 2005 | 36 | 53 | 36 |
Guo [25] | 2005 | 22 | 68 | 48 |
Masci [46] | 2005 | 41 | NA | 53 |
Senen [57] | 2005 | 21 | 48 | 56 |
Pasqui [51] | 2005 | 30 | 60 | 54 |
Sestito [58] | 2005 | 30 | 73 | 60 |
De Candia [16] | 2005 | 21 | 57 | 55 |
Valeriani [62] | 2005 | 16 | 50 | 60 |
Cavusoglu [8] | 2005 | 31 | 45 | 52 |
Kolasinska-Kloch [36] | 2004 | 42 | 52 | 46 |
Kolasilska-Kloch [35] | 2004 | 25 | 36 | 49 |
Altun [3] | 2004 | 8 | 75 | 46 |
Asbury [4] | 2004 | 100 | 100 | 61 |
Fabian [20] | 2004 | 40 | 40 | 55 |
Lanza [39] | 2004 | 55 | 50 | 57 |
Qian [54] | 2004 | 126 | 47 | 53 |
Osamichi [50] | 2004 | 24 | 71 | 58 |
Gorgulu [22] | 2003 | 18 | 44 | 51 |
Pizzi [53] | 2004 | NA | NA | 59 |
Kidawa [34] | 2003 | 50 | 64 | 49 |
CSX incidence
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Original CAGs or clinical data could not be found for eight patients, leaving 559 cases for analysis.
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Out of the available 559 CAGs 78 (14%) were considered as absolutely normal.
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Another 15 cases were excluded owing to the lack of exercise stress tests or myocardial perfusion imaging preceding the CAG.
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Of the remaining 45 cases, 28 were included owing to positive results for ischaemia from exercise tests or SPECT.
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Finally, a much stricter definition of CSX was obtained by using the main exclusion criteria shown in the second-to-last stage in Fig. 2. This strict definition resulted in an attributable CSX incidence of 18 (3%) patients.