CORONARY FLOW RESERVE AND ESOPHAGEAL DYSFUNCTION IN SYNDROME-X

The relative prevalence of abnormalities of coronary flow reserve and oesophageal function was ascertained in 32 syndrome X patients with ty pical angina chest pain, a positive exercise test, and normal coronary arteries. Coronary flow reserve in response to a hyperaemic dose of p apaverine was measured using an intracoronary Doppler catheter positio ned in the left anterior descending coronary artery. coronary flow res erve as being < 3.0. Patients were investigated for oesophageal dysfun ction by manometry and 24-hour pH monitoring. Thirteen patients had an impaired coronary how reserve (group 1) and 19 patients had a normal how reserve (group 2). Eight of the 13 group 1 patients (62%) and 13 o f the 19 group 2 patients (68%, p = NS) had evidence of oesophageal dy sfunction on either manometry or pH studies. Therefore, a total of 26 (81%) syndrome X patients had either an abnormality of coronary flow r eserve or oesophageal dysfunction suggesting that chest pain in these patients may be due to myocardial ischaemia or oesophageal dysfunction , thus confirming the heterogeneous nature of this syndrome. The preva lence of oesophageal abnormalities was independent of any abnormalitie s of coronary flow reserve.