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European Heart Journal 2001 22(13):1144-1148; doi:10.1053/euhj.2000.2442
Copyright © 2001 by the European Society of Cardiology.
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Rarefaction of skin capillaries in patients with anginal chest pain and normal coronary arteriograms

T.F.T Antoniosa,f1, J.C Kaskib, K.M Hasana, S.J Brownb and D.R.J Singera

a Clinical Pharmacology Unit, Department of Pharmacology & Clinical Pharmacology, St George's Hospital Medical School, Cranmer Terrace, London, U.K.
b Coronary Artery Disease Research Unit, St George's Hospital Medical School, Cranmer Terrace, London, U.K.

revised September 5, 2000; accepted September 6, 2000

Abstract

Aims Patients with arterial hypertension often have a reduction in capillary density (rarefaction) and a reduction in coronary flow reserve because of functional and structural alterations of the coronary microcirculation. Patients with chest pain and normal coronary arteriograms may have coronary microvascular dysfunction, but it is not known whether capillary rarefaction plays a role in the pathogenesis of this syndrome. The aim of this study was to compare capillary density in hypertensive and normotensive subjects with anginal chest pain and normal coronary arteriograms vs asymptomatic hypertensives and healthy controls.

Methods and Results We studied 49 patients with typical anginal chest pain, positive exercise testing and normal coronary arteriograms; 22 were hypertensive and 27 were normotensive. We used intra-vital video-microscopy to examine the skin of the dorsum of the middle finger of the non-dominant hand before and after maximization of perfused capillaries with venous congestion. Mean capillary density was significantly lower in patients with chest pain and normal coronary arteriograms independent of their blood pressure level, compared to normotensive healthy controls. Differences were found both at baseline [51±2 (hypertensive) and 52±2 (normotensive) vs 65±2 (controls) per 0·56mm2respectively], (P<0·0001) and after maximization [57±3 (hypertensive) and 59±2 (normotensive) versus 75±3 (controls) respectively] (P<0·0001).

Conclusions Skin capillary density is significantly lower in patients with chest pain and normal coronary arteriograms compared to normotensive controls. The pathophysiological importance of capillary rarefaction in patients with chest pain and normal coronary arteriograms remains unknown. Further studies are needed to determine whether the abnormality is associated with myocardial flow disturbances such that the findings can be extended to the heart.

Key Words: Chest pain and normal coronary arteries, essential hypertension, microcirculation, capillary rarefaction

f1 Correspondence: Dr Tarek F. Antonios, MBChB, MSc, MD, MRCP, Blood Pressure Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, U.K.

References

  1. Kemp HG, Kromal RA, Vlietstra RE, Frye RL. Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol. 1986;7:479–483[Abstract]
  2. Cannon RO, Epstein SE. "Microvascular angina" as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol. 1988;61:1338–1343[CrossRef][ISI][Medline]
  3. Opherk D, Zebe H, Weihe E. Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. Circulation. 1981;63:817–825[Abstract/Free Full Text]
  4. Lucarini AR, Picano E, Salvetti A. Coronary microvascular disease in hypertensives. Clin Exp Hypertens. 1992;14:55–66
  5. Prasad A, Dunnill GS, Mortimer PS, MacGregor GA. Capillary rarefaction in the forearm skin in essential hypertension. J of Hypertens. 1995;13:265–268[ISI][Medline]
  6. Gasser P, Buhler FR. Nailfold microcirculation in normotensive and essential hypertensive subjects, as assessed by video-microscopy. J Hypertens. 1992;10:83–86[CrossRef][ISI][Medline]
  7. Antonios TFT, Singer DR, Markandu ND, Mortimer PS, MacGregor GA. Structural skin capillary rarefaction in essential hypertension. Hypertension. 1999;33:998–1001[Abstract/Free Full Text]
  8. Antonios TFT, Singer DR, Markandu ND, Mortimer PS, MacGregor GA. Rarefaction of skin capillaries in borderline essential hypertension suggests an early structural abnormality. Hypertension. 1999;34:655–658[Abstract/Free Full Text]
  9. Antonios TFT, Rattray FE, Singer DRJ, Markandu ND, Mortimer PS, MacGregor GA. Rarefaction of skin capillaries in normotensive offspring of patients with essential hypertension. Hypertension. 1999;34:699
  10. Antonios TFT, Rattray FE, Singer DR, Markandu ND, Mortimer PS, MacGregor GA. Maximization of skin capillaries during intravital video-microscopy in essential hypertension: comparison between venous congestion, reactive hyperaemia and core heat load tests. Clin Sci. 1999;97:523–528[Medline]
  11. O'Brien E, Mee F, Atkins N, Thomas M. Evaluation of three devices for self-measurement of blood pressure according to the revised British Hypertension Society Protocol: the Omron HEM-705CP, Philips HP5332, and Nissei DS-175. Blood Press Monit. 1996;1:55–61[Medline]
  12. Conway J. A vascular abnormality in hypertension: a study of blood flow in the forearm. Circulation. 1963;27:520–529[Abstract/Free Full Text]
  13. Takeshita A, Mark AL. Decreased vasodilator capacity of forearm resistance vessels in borderline hypertension. Hypertension. 1980;2:610–616[Free Full Text]
  14. Mark AL. Structural changes in resistance and capacitance vessels in borderline hypertension. Hypertension. 1984;6:III69–73[Medline]
  15. Takeshita A, Imaizumi T, Ashihara T, Yamamoto K, Hoka S, Nakamura M. Limited maximal vasodilator capacity of forearm resistance vessels in normotensive young men with a familial predisposition to hypertension. Circ Res. 1982;50:671–677[Abstract/Free Full Text]
  16. Kaski JC, Rosano GM, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA. Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol. 1995;25:807–814[Abstract]
  17. Botker HE, Moller N, Ovesen P. Insulin resistance in microvascular angina (syndrome X). Lancet. 1993;342:136–140[CrossRef][ISI][Medline]
  18. Fuh MM, Jeng CY, Young MM, Sheu WH, Chen YD, Reaven GM. Insulin resistance, glucose intolerance, and hyperinsulinemia in patients with microvascular angina. Metabolism. 1993;42:1090–1092[CrossRef][ISI][Medline]
  19. Dean JD, Jones CJ, Hutchison SJ, Peters JR, Henderson AH. Hyperinsulinaemia and microvascular angina ("syndrome X"). Lancet. 1991;337:456–457[CrossRef][ISI][Medline]
  20. Ferrannini E, Buzzigoli G, Bonadonna R. Insulin resistance in essential hypertension. N Engl J Med. 1987;317:350–357[Abstract]
  21. Ferrannini E. Insulin and blood pressure: possible role of hemodynamics. Clin Exp Hypertens. 1992;14:271–284
  22. Hattersley AT, Tooke JE. The fetal insulin hypothesis: an alternative explanation of the association of low birthweight with diabetes and vascular disease. Lancet. 1999;353:1789–1792[CrossRef][ISI][Medline]
  23. Shapiro LM, Crake T, Poole-Wilson PA. Is altered cardiac sensation responsible for chest pain in patients with normal coronary arteries? Clinical observation during cardiac catheterisation. Br Med J. 1988;296:170–171[ISI][Medline]
  24. Turiel M, Galassi AR, Glazier JJ, Kaski JC, Maseri A. Pain threshold and tolerance in women with syndrome X and women with stable angina pectoris. Am J Cardiol. 1987;60:503–507[CrossRef][ISI][Medline]
  25. Suzuki H, Koba S, Katagiri T, Takeyama Y, Suwa Y. Ultrastructural changes of blood capillaries in patients with microvascular angina, hypertrophic cardiomyopathy, and dilated cardiomyopathy. Am J Cardiovasc Pathol. 1995;5:19–26[Medline]
  26. Mosseri M, Yarom R, Gotsman MS, Hasin Y. Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries. Circulation. 1986;74:964–972[Abstract/Free Full Text]
  27. Buchthal SD, Den Hollander JA, Merz CN. Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms. N Engl J Med. 2000;342:829–835[Abstract/Free Full Text]
  28. Cannon RO, Peden DB, Berkebile C, Schenke WH, Kaliner MA, Epstein SE. Airway hyperresponsiveness in patients with microvascular angina. Evidence for a diffuse disorder of smooth muscle responsiveness. Circulation. 1990;82:2011–2017[Abstract/Free Full Text]
  29. Sax FL, Cannon ROD, Hanson C, Epstein SE. Impaired forearm vasodilator reserve in patients with microvascular angina. Evidence of a generalized disorder of vascular function? N Engl J Med. 1987;317:1366–1370[Abstract]
  30. Pedrinelli R, Spessot M, Lorenzoni R. Forearm vasodilatory capacity in patients with syndrome X: a comparison with normal and hypertensive subjects. J Hypertens. 1989;7:S92–93
  31. Buus NH, Bottcher M, Bottker HE, Sorensen KE, Nielsen TT, Mulvany MJ. Reduced vasodilator capacity in syndrome X related to structure and function of resistance arteries. Am J Cardiol. 1999;83:149–154[CrossRef][ISI][Medline]
  32. Botker HE, Sonne HS, Sorensen KE. Frequency of systemic microvascular dysfunction in syndrome X and in variant angina. Am J Cardiol. 1996;78:182–186[ISI][Medline]

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