Evaluation of aortic elasticity and epicardial fatty tissue thickness of patients with cardiac syndrome X

Coronary artery disease constitutes a major part of deaths worldwide. It often appears with angina pectoris tableau. In spite of that in various studies, patients who are evaluated for coronery artery as a result of angina pectoris have %10-30 normal coronary arteries (1-6). Cardiac Syndrome X is defined as patients who have normal coronary arteries despite of angina, chest pain similar to angina, ischemic ECG variance on effort test or identified local myocardial perfusion on SPECT or PET scanning, ischemia on myocard perfusion scintigraphy. Previously prognosis of this disease was known as good, recent studies show cardiac syndrome x patients with endothelial dysfunction have poor prognosis (II) and %10-20 percent of diagnosed patients hospitalize with the diagnosis of acute coronary syndrome between 2-3 years. In our research elastic properties, epicardial fat thickness and findings of echocardiography of cardiac syndrome x patients and control group will be compared and importance of these parameters will be presented. This study is prepared prospectively and patients who are between 18-55 years old and applied to Bozok University Faculty of Medicine between November 15th 2015 and November 15th 2016 because of chest pain are included. As a result of noninvasive examination ischemia is detected and coronary angiography is planned. After exclusion criteria patients with normal coronary anatomy and ischemic proof are included. Biochemistry facts, physical characteristics of patients are recorded. Clinical and ecocardiographic evaluation of all patients is carried out. With echocardiographic examination left ventricular ejection fraction, tranmitral flow E and A waves, pulsed wave tissue doppler, lateral wall E', A', Sm measurements, cardiac cavity size, wall thickness, M mode, systolic and diastolic aortic diameter, epicardial fatty tissue thickness is measured and compared to control group. No statistically significant difference is found between two groups in terms of age, sex and other demographic features (p>0,05). Systolic and diastolic aortic diameter in patient group is significantly high (p=0,001). Likewise, in patient group aortic stiffness index is high compared to control group (p=0,001) ın group of cardiac syndrome x, epicardial fatty tissue is significantly high (p<0,001). E/A ratio in transmitral flow measurements which provide insight for diastolic functions of left ventricle is significantly low (p<0,001). In pulsed wave tissue doppler examination showing diastolic functions although there is no difference in lateral wall, e' and Sm waves, A wave is significantly high (p<0,001). E'/A' ratio is significantly low in patient group (p<0,001). White blood cell count and C reactive protein amount, inflammation parameter laboratory investigation, is significantly high (p<0,001). As a result, in group of patients with cardiac syndrome X aortic stiffness index is high, aortic distensibility showing aortic compliance is low. Epicardial fatty tissue thickness is high. Transmitral flow E/A ratio and that shows left ventricular dysfunction and lateral wall tissue doppler E'/A' ratio is low. This levels suggest that there might be diastolic dysfunction. Moreover white blood cells and C reactive protein, infalmmation parameters, are high. Key Words: Cardiac syndrome X, Aortic stiffness, Epicardial fatty tissue, Echocardiography.