FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 328:1659-1664 June 10, 1993 Number 23 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background A group of patients has been described who have chest pain resembling angina and positive exercise tests, but normal coronary angiograms and no coronary-artery spasm. This constellation of features has sometimes been called syndrome X or microvascular angina. We attempted to determine whether endothelium-dependent vasodilatation of the coronary vasculature was impaired in patients with this syndrome.

Methods We infused the endothelium-dependent vasodilator acetylcholine and the endothelium-independent vasodilators papaverine and isosorbide dinitrate into the left coronary artery of 9 patients and 10 control subjects. The diameter of the left anterior descending coronary artery was assessed by quantitative angiography, and changes in coronary blood flow were estimated with the use of an intracoronary Doppler catheter.

Results Acetylcholine, given in doses of 1, 3, 10, and 30 µg per minute, increased coronary blood flow in a dose-dependent manner in both groups. However, the mean (±SD) acetylcholine-induced increases in coronary blood flow were significantly less (P<0.001) in the patients (8 ±14, 37 ±37, 59 ±67, and 103 ±77 percent, respectively) than in the controls (62 ±52, 186 ±93, 341 ±128, and 345 ±78 percent, respectively). The changes in coronary blood flow in response to 2 mg of isosorbide dinitrate (236 ±66 percent vs. 280 ±56 percent) and 10 mg of papaverine (366 ±168 percent vs. 411 ±92 percent) did not differ significantly between the patients and controls. The administration of papaverine resulted in myocardial lactate production in the patients but not in the controls. The three lower doses of acetylcholine caused a similar degree of dilatation of the left anterior descending coronary artery in the two groups, and the highest dose caused a similar degree of constriction in the two groups. Isosorbide dinitrate and papaverine caused a similar degree of dilatation in both groups.

Conclusions These findings suggest that endothelium-dependent dilatation of the resistance coronary arteries is defective in patients with anginal chest pain and normal coronary arteries, which may contribute to the altered regulation of myocardial perfusion in these patients.

Source Information

From the Research Institute of Angiocardiology and the Cardiovascular Clinic, Kyushu University School of Medicine, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812, Japan, where reprint requests should be addressed to Dr. Egashira.

Full Text of this Article

Related Letters:

Endothelial Dysfunction in Microvascular Angina
Rossen J. D., Agmon Y., Gorlin R., Abbott E.C., Egashira K., Takeshita A.
Extract | Full Text  
N Engl J Med 1993; 329:1739-1740, Dec 2, 1993. Correspondence

This article has been cited by other articles:

• Glossop, A., Dobbs, P. (2008). Coronary artery vasospasm during awake deep brain stimulation surgery. Br J Anaesth 101: 222-224 [Abstract] [Full Text]  
• Stangl, V., Witzel, V., Baumann, G., Stangl, K. (2008). Current diagnostic concepts to detect coronary artery disease in women. Eur Heart J 29: 707-717 [Abstract] [Full Text]  
• Lanza, G. A., Buffon, A., Sestito, A., Natale, L., Sgueglia, G. A., Galiuto, L., Infusino, F., Mariani, L., Centola, A., Crea, F. (2008). Relation between stress-induced myocardial perfusion defects on cardiovascular magnetic resonance and coronary microvascular dysfunction in patients with cardiac syndrome X.. J Am Coll Cardiol 51: 466-472 [Abstract] [Full Text]  
• Huang, P.-H., Chen, Y.-H., Chen, Y.-L., Wu, T.-C., Chen, J.-W., Lin, S.-J. (2007). Vascular endothelial function and circulating endothelial progenitor cells in patients with cardiac syndrome X. Heart 93: 1064-1070 [Abstract] [Full Text]  
• Wang, J. J., Liew, G., Klein, R., Rochtchina, E., Knudtson, M. D., Klein, B. E.K., Wong, T. Y., Burlutsky, G., Mitchell, P. (2007). Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations. Eur Heart J 28: 1984-1992 [Abstract] [Full Text]  
• Vermeltfoort, I. A.C., Bondarenko, O., Raijmakers, P. G.H.M., Odekerken, D. A.M., Kuijper, A. F.M., Zwijnenburg, A., van der Vis-Melsen, M. J.E., Twisk, J. W.R., Beek, A. M., Teule, G. J.J., van Rossum, A. C. (2007). Is subendocardial ischaemia present in patients with chest pain and normal coronary angiograms? A cardiovascular MR study. Eur Heart J 28: 1554-1558 [Abstract] [Full Text]  
• Lanza, G A (2007). Cardiac syndrome X: a critical overview and future perspectives. Heart 93: 159-166 [Abstract] [Full Text]  
• Wong, T. Y., Kamineni, A., Klein, R., Sharrett, A. R., Klein, B. E., Siscovick, D. S., Cushman, M., Duncan, B. B. (2006). Quantitative Retinal Venular Caliber and Risk of Cardiovascular Disease in Older Persons: The Cardiovascular Health Study. Arch Intern Med 166: 2388-2394 [Abstract] [Full Text]  
• Kaski, J C (2006). Cardiac syndrome X in women: the role of oestrogen deficiency. Heart 92: iii5-iii9 [Abstract] [Full Text]  
• Hatoum, O. A., Otterson, M. F., Kopelman, D., Miura, H., Sukhotnik, I., Larsen, B. T., Selle, R. M., Moulder, J. E., Gutterman, D. D. (2006). Radiation Induces Endothelial Dysfunction in Murine Intestinal Arterioles via Enhanced Production of Reactive Oxygen Species. Arterioscler. Thromb. Vasc. Bio. 26: 287-294 [Abstract] [Full Text]  
• Hatoum, O. A., Gauthier, K. M., Binion, D. G., Miura, H., Telford, G., Otterson, M. F., Campbell, W. B., Gutterman, D. D. (2005). Novel Mechanism of Vasodilation in Inflammatory Bowel Disease. Arterioscler. Thromb. Vasc. Bio. 25: 2355-2361 [Abstract] [Full Text]  
• Madaric, J., Bartunek, J., Verhamme, K., Penicka, M., Van Schuerbeeck, E., Nellens, P., Heyndrickx, G. R., Wijns, W., Vanderheyden, M., De Bruyne, B. (2005). Hyperdynamic Myocardial Response to Beta-Adrenergic Stimulation in Patients With Chest Pain and Normal Coronary Arteries. J Am Coll Cardiol 46: 1270-1275 [Abstract] [Full Text]  
• Valeriani, M., Sestito, A., Pera, D. L., Armas, L. D., Infusino, F., Maiese, T., Sgueglia, G. A., Tonali, P. A., Crea, F., Restuccia, D., Lanza, G. A. (2005). Abnormal cortical pain processing in patients with cardiac syndrome X. Eur Heart J 26: 975-982 [Abstract] [Full Text]  
• Masaki, N., Takase, B., Satomura, K., Akima, T., Matsushima, Y., Hosaka, H., Hamabe, A., Kurita, A., Ohsuzu, F. (2005). Provocation of Microvessel Spasm by Low-Dose Acetylcholine in Patients with Suspected Coronary Artery Disease: Two Case Reports. ANGIOLOGY 56: 211-216 [Abstract]  
• Jadhav, S, Petrie, J, Ferrell, W, Cobbe, S, Sattar, N (2004). Insulin resistance as a contributor to myocardial ischaemia independent of obstructive coronary atheroma: a role for insulin sensitisation?. Heart 90: 1379-1383 [Abstract] [Full Text]  
• Bugiardini, R., Manfrini, O., Pizzi, C., Fontana, F., Morgagni, G. (2004). Endothelial Function Predicts Future Development of Coronary Artery Disease: A Study of Women With Chest Pain and Normal Coronary Angiograms. Circulation 109: 2518-2523 [Abstract] [Full Text]  
• Redberg, R. F., Cannon, R. O. III, Bairey Merz, N., Lerman, A., Reis, S. E., Sheps, D. S., Endorsed by the American College of Cardiology Fou, (2004). Women's Ischemic Syndrome Evaluation: Current Status and Future Research Directions: Report of the National Heart, Lung and Blood Institute Workshop: October 2-4, 2002: Section 2: Stable Ischemia: Pathophysiology and Gender Differences. Circulation 109 : e47-e49 [Full Text]  
• Kaski, J. C. (2004). Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X). Circulation 109: 568-572 [Full Text]  
• Pizzi, C., Manfrini, O., Fontana, F., Bugiardini, R. (2004). Angiotensin-Converting Enzyme Inhibitors and 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase in Cardiac Syndrome X: Role of Superoxide Dismutase Activity. Circulation 109: 53-58 [Abstract] [Full Text]  
• Arroyo-Espliguero, R., Mollichelli, N., Avanzas, P., Zouridakis, E., Newey, V. R, Nassiri, D. K, Kaski, J. C. (2003). Chronic inflammation and increased arterial stiffness in patients with cardiac syndrome X. Eur Heart J 24: 2006-2011 [Abstract] [Full Text]  
• de Simone, G. (2003). Left Ventricular Geometry and Hypotension in End-Stage Renal Disease: A Mechanical Perspective. J. Am. Soc. Nephrol. 14: 2421-2427 [Abstract] [Full Text]  
• Cosin-Sales, J., Pizzi, C., Brown, S., Kaski, J. C. (2003). C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms. J Am Coll Cardiol 41: 1468-1474 [Abstract] [Full Text]  
• Lanza, G. A., Sestito, A., Iacovella, S., Morlacchi, L., Romagnoli, E., Schiavoni, G., Crea, F., Maseri, A., Andreotti, F. (2003). Relation Between Platelet Response to Exercise and Coronary Angiographic Findings in Patients With Effort Angina. Circulation 107: 1378-1382 [Abstract] [Full Text]  
• Bonetti, P. O., Lerman, L. O., Lerman, A. (2003). Endothelial Dysfunction: A Marker of Atherosclerotic Risk. Arterioscler. Thromb. Vasc. Bio. 23: 168-175 [Abstract] [Full Text]  
• Piatti, P., Fragasso, G., Monti, L. D., Setola, E., Lucotti, P., Fermo, I., Paroni, R., Galluccio, E., Pozza, G., Chierchia, S., Margonato, A. (2003). Acute Intravenous l-Arginine Infusion Decreases Endothelin-1 Levels and Improves Endothelial Function in Patients With Angina Pectoris and Normal Coronary Arteriograms: Correlation With Asymmetric Dimethylarginine Levels. Circulation 107: 429-436 [Abstract] [Full Text]  
• Palinkas, A., Toth, E., Amyot, R., Rigo, F., Venneri, L., Picano, E. (2002). The value of ECG and echocardiography during stress testing for identifying systemic endothelial dysfunction and epicardial artery stenosis. Eur Heart J 23: 1587-1595 [Abstract] [Full Text]  
• Lanza, G A, Crea, F (2002). The complex link between brain and heart in cardiac syndrome X. Heart 88: 328-330 [Full Text]  
• Oskarsson, G., Pesonen, E., Munkhammar, P., Sandstrom, S., Jogi, P. (2002). Normal Coronary Flow Reserve After Arterial Switch Operation for Transposition of the Great Arteries: An Intracoronary Doppler Guidewire Study. Circulation 106: 1696-1702 [Abstract] [Full Text]  
• Theilmeier, G., Verhamme, P., Dymarkowski, S., Beck, H., Bernar, H., Lox, M., Janssens, S., Herregods, M.-C., Verbeken, E., Collen, D., Plate, K., Flameng, W., Holvoet, P. (2002). Hypercholesterolemia in Minipigs Impairs Left Ventricular Response to Stress: Association With Decreased Coronary Flow Reserve and Reduced Capillary Density. Circulation 106: 1140-1146 [Abstract] [Full Text]  
• Wong, T. Y., Klein, R., Sharrett, A. R., Duncan, B. B., Couper, D. J., Tielsch, J. M., Klein, B. E. K., Hubbard, L. D. (2002). Retinal Arteriolar Narrowing and Risk of Coronary Heart Disease in Men and Women: The Atherosclerosis Risk in Communities Study. JAMA 287: 1153-1159 [Abstract] [Full Text]  
• Kaski, J. C. (2002). Overview of gender aspects of cardiac syndrome X. Cardiovasc Res 53: 620-626 [Abstract] [Full Text]  
• Lanza, G.A., Andreotti, F., Sestito, A., Sciahbasi, A., Crea, F., Maseri, A. (2001). Platelet aggregability in cardiac syndrome X. Eur Heart J 22: 1924-1930 [Abstract]  
• Schwartz, L., Bourassa, M. G. (2001). Evaluation of Patients With Chest Pain and Normal Coronary Angiograms. Arch Intern Med 161: 1825-1833 [Full Text]  
• Setoguchi, S., Mohri, M., Shimokawa, H., Takeshita, A. (2001). Tetrahydrobiopterin improves endothelial dysfunction in coronary microcirculation in patients without epicardial coronary artery disease. J Am Coll Cardiol 38: 493-498 [Abstract] [Full Text]  
• Goel, P. K., Gupta, S. K., Agarwal, A., Kapoor, A. (2001). Slow Coronary Flow: A Distinct Angiographic Subgroup in Syndrome X. ANGIOLOGY 52: 507-514 [Abstract]  
• Buffon, A., Rigattieri, S., Santini, S. A., Ramazzotti, V., Crea, F., Giardina, B., Maseri, A. (2000). Myocardial ischemia-reperfusion damage after pacing-induced tachycardia in patients with cardiac syndrome X. Am. J. Physiol. Heart Circ. Physiol. 279: H2627-H2633 [Abstract] [Full Text]  
• Eriksson, B. E., Tyni-Lenne, R., Svedenhag, J., Hallin, R., Jensen-Urstad, K., Jensen-Urstad, M., Bergman, K., Sylven, C. (2000). Physical training in Syndrome X: Physical training counteracts deconditioning and pain in Syndrome X. J Am Coll Cardiol 36: 1619-1625 [Abstract] [Full Text]  
• Roe, M. T., Harrington, R. A., Prosper, D. M., Pieper, K. S., Bhatt, D. L., Lincoff, A. M., Simoons, M. L., Akkerhuis, M., Ohman, E. M., Kitt, M. M., Vahanian, A., Ruzyllo, W., Karsch, K., Califf, R. M., Topol, E. J. (2000). Clinical and Therapeutic Profile of Patients Presenting With Acute Coronary Syndromes Who Do Not Have Significant Coronary Artery Disease. Circulation 102: 1101-1106 [Abstract] [Full Text]  
• PIATTI, P. M., MONTI, L. D., ZAVARONI, I., VALSECCHI, G., VAN PHAN, C., COSTA, S., CONTI, M., SANDOLI, E. P., SOLERTE, B., POZZA, G., PONTIROLI, A. E., REAVEN, G. (2000). Alterations in Nitric Oxide/Cyclic-GMP Pathway in Nondiabetic Siblings of Patients with Type 2 Diabetes. J. Clin. Endocrinol. Metab. 85: 2416-2420 [Abstract] [Full Text]  
• Buchthal, S. D., den Hollander, J. A., Merz, C. N. B., Rogers, W. J., Pepine, C. J., Reichek, N., Sharaf, B. L., Reis, S., Kelsey, S. F., Pohost, G. M. (2000). Abnormal Myocardial Phosphorus-31 Nuclear Magnetic Resonance Spectroscopy in Women with Chest Pain but Normal Coronary Angiograms. NEJM 342: 829-835 [Abstract] [Full Text]  
• Iemura, M, Ishii, M, Sugimura, T, Akagi, T, Kato, H (2000). Long term consequences of regressed coronary aneurysms after Kawasaki disease: vascular wall morphology and function. Heart 83: 307-311 [Abstract] [Full Text]  
• Sztajzel, J., Mach, F., Righetti, A. (2000). Current concepts in medicine: Role of the vascular endothelium in patients with angina pectoris or acute myocardial infarction with normal coronary arteries. Postgrad. Med. J. 76: 16-21 [Abstract] [Full Text]  
• Piatti, P., Fragasso, G., Monti, L. D., Caumo, A., Van Phan, C., Valsecchi, G., Costa, S., Fochesato, E., Pozza, G., Pontiroli, A. E., Chierchia, S. (1999). Endothelial and metabolic characteristics of patients with angina and angiographically normal coronary arteries: Comparison with subjects with insulin resistance syndrome and normal controls. J Am Coll Cardiol 34: 1452-1460 [Abstract] [Full Text]  
• Schachinger, V., Britten, M. B., Elsner, M., Walter, D. H., Scharrer, I., Zeiher, A. M. (1999). A Positive Family History of Premature Coronary Artery Disease Is Associated With Impaired Endothelium-Dependent Coronary Blood Flow Regulation. Circulation 100: 1502-1508 [Abstract] [Full Text]  
• Cox, I. D., Botker, H. E., Bagger, J. P., Sonne, H. S., Kristensen, B. O, Kaski, J. C. (1999). Elevated endothelin concentrations are associated with reduced coronary vasomotor responses in patients with chest pain and normal coronary arteriograms. J Am Coll Cardiol 34: 455-460 [Abstract] [Full Text]  
• Park, K. W., Tofukuji, M., Metais, C., Comunale, M. E., Dai, H. B., Simons, M., Stahl, G. L., Agah, A., Sellke, F. W. (1999). Attenuation of Endothelium-Dependent Dilation of Pig Pulmonary Arterioles After Cardiopulmonary Bypass Is Prevented by Monoclonal Antibody to Complement C5a. Anesth. Analg. 89: 42-42 [Abstract] [Full Text]  
• Baller, D., Notohamiprodjo, G., Gleichmann, U., Holzinger, J., Weise, R., Lehmann, J. (1999). Improvement in Coronary Flow Reserve Determined by Positron Emission Tomography After 6 Months of Cholesterol-Lowering Therapy in Patients With Early Stages of Coronary Atherosclerosis. Circulation 99: 2871-2875 [Abstract] [Full Text]  
• Kusterer, K., Pohl, T., Fortmeyer, H.-P., Marz, W., Scharnagl, H., Oldenburg, A., Angermuller, S., Fleming, I., Usadel, K. H., Busse, R. (1999). Chronic selective hypertriglyceridemia impairs endothelium-dependent vasodilatation in rats. Cardiovasc Res 42: 783-793 [Abstract] [Full Text]  
• Reis, S. E., Holubkov, R., Lee, J. S., Sharaf, B., Reichek, N., Rogers, W. J., Walsh, E. G., Fuisz, A. R., Kerensky, R., Detre, K. M., Sopko, G., Pepine, C. J., for the WISE Investigators, (1999). Coronary flow velocity response to adenosine characterizes coronary microvascular function in women with chest pain and no obstructive coronary disease: Results from the pilot phase of the Women's Ischemia Syndrome Evaluation (WISE) Study. J Am Coll Cardiol 33: 1469-1475 [Abstract] [Full Text]  
• Bottcher, M., Botker, H. E., Sonne, H., Nielsen, T. T., Czernin, J. (1999). Endothelium-Dependent and -Independent Perfusion Reserve and the Effect of L-arginine on Myocardial Perfusion in Patients With Syndrome X. Circulation 99: 1795-1801 [Abstract] [Full Text]  
• Pitkanen, O.-P., Nuutila, P., Raitakari, O. T., Porkka, K., Iida, H., Nuotio, I., Ronnemaa, T., Viikari, J., Taskinen, M.-R., Ehnholm, C., Knuuti, J. (1999). Coronary Flow Reserve in Young Men With Familial Combined Hyperlipidemia. Circulation 99: 1678-1684 [Abstract] [Full Text]  
• Hartmann, A., Reuss, W., Burger, W., Kneissl, G.-D., Rothe, W., Beyersdorf, F. (1999). Endothelium-dependent and endothelium-independent flow reserve in vascular regions supplied by the internal mammary artery before and after bypass grafting. Eur. J. Cardiothorac. Surg. 13: 410-415 [Abstract] [Full Text]  
• Botker, H. E., Sonne, H. S., Frobert, O., Andreasen, F. (1999). Enhanced exercise-induced hyperkalemia in patients with syndrome X. J Am Coll Cardiol 33: 1056-1061 [Abstract] [Full Text]  
• Kal, J. E., Vergroesen, I., van Wezel, H. B. (1999). The Effect of Nitroglycerin on Pacing-Induced Changes in Myocardial Oxygen Consumption and Metabolic Coronary Vasodilation in Patients with Coronary Artery Disease. Anesth. Analg. 88: 271-271 [Abstract] [Full Text]  
• Neumann, F.-J., Blasini, R., Schmitt, C., Alt, E., Dirschinger, J., Gawaz, M., Kastrati, A., Schomig, A. (1998). Effect of Glycoprotein IIb/IIIa Receptor Blockade on Recovery of Coronary Flow and Left Ventricular Function After the Placement of Coronary-Artery Stents in Acute Myocardial Infarction. Circulation 98: 2695-2701 [Abstract] [Full Text]  
• Gaspardone, A., Ferri, C., Crea, F., Versaci, F., Tomai, F., Santucci, A., Chiariello, L., Gioffre, P. A. (1998). Enhanced activity of sodium-lithium countertransport in patients with cardiac syndrome X: A potential link between cardiac and metabolic syndrome X. J Am Coll Cardiol 32: 2031-2034 [Abstract] [Full Text]  
• Goodfellow, J., Bellamy, M. F, Gorman, S. T, Brownlee, M., Ramsey, M. W, Lewis, M. J, Davies, D. P, Henderson, A. H (1998). Endothelial function is impaired in fit young adults of low birth weight. Cardiovasc Res 40: 600-606 [Abstract] [Full Text]  
• Murakami, H., Urabe, K., Nishimura, M. (1998). Inappropriate microvascular constriction produced transient ST-segment elevation in patients with syndrome X. J Am Coll Cardiol 32: 1287-1294 [Abstract] [Full Text]  
• Bellamy, M. F, Goodfellow, J., Tweddel, A. C, Dunstan, F. D.J, Lewis, M. J, Henderson, A. H (1998). Syndrome X and endothelial dysfunction. Cardiovasc Res 40: 410-417 [Abstract] [Full Text]  
• Takata, S., Shimakura, A., Sakagami, S., Nakamura, Y., Ohkuwa, H., Kobayashi, K.-i., Nagai, H. (1998). Enhanced Insulin Response to Oral Glucose Load in Patients with Angina Pectoris Associated with ST Segment Elevation in the Absence of Epicardial Coronary Arterial Obstruction. ANGIOLOGY 49: 815-826 [Abstract]  
• Makita, S., Nakamura, M., Ohira, A., Ito, S., Yoshioka, K., Hirose, A., Nakajima, T., Komoda, K., Kawazoe, K., Hiramori, K. (1998). Impaired Peripheral Vasodilation in Ischemic and Nonischemic Limbs of Patients with Unilateral Arteriosclerosis Obliterans: Effect of Revascularization on Leg Hemodynamics. VASC ENDOVASCULAR SURG 32: 491-502 [Abstract]  
• Node, K., Kitakaze, M., Sato, H., Koretsune, Y., Karita, M., Kosaka, H., Hori, M. (1998). Increased release of nitric oxide in ischemic hearts after exercise in patients with effort angina. J Am Coll Cardiol 32: 63-68 [Abstract] [Full Text]  
• Ritchie, R. H., Marsh, J. D., Lancaster, W. D., Diglio, C. A., Schiebinger, R. J. (1998). Bradykinin Blocks Angiotensin II-Induced Hypertrophy in the Presence of Endothelial Cells. Hypertension 31: 39-44 [Abstract] [Full Text]  
• Hasdai, D., Gibbons, R. J., Holmes, D. R. Jr, Higano, S. T., Lerman, A. (1997). Coronary Endothelial Dysfunction in Humans Is Associated With Myocardial Perfusion Defects. Circulation 96: 3390-3395 [Abstract] [Full Text]  
• Maeda, N., Hiraoka, H., Nakamura, T., Matsuura, F., Ouchi, N., Nakata, A., Kobayashi, H., Yamashita, S., Kameda-Takemura, K., Matsuzawa, Y., Nakamura, T. (1997). Acetylcholine-Induced Coronary Microvascular Vasospasm in a Patient with Angina Pectoris and Normal Coronary Angiogram: A Case Report. ANGIOLOGY 48: 995-999 [Abstract]  
• Mohri, M., Egashira, K., Tagawa, T., Kuga, T., Tagawa, H., Harasawa, Y., Shimokawa, H., Takeshita, A. (1997). Basal Release of Nitric Oxide Is Decreased in the Coronary Circulation in Patients With Heart Failure. Hypertension 30: 50-56 [Abstract] [Full Text]  
• Ossei-Gerning, N., Mansfield, M. W., Stickland, M. H., Wilson, I. J., Grant, P. J. (1997). Plasminogen Activator Inhibitor-1 Promoter 4G/5G Genotype and Plasma Levels in Relation to a History of Myocardial Infarction in Patients Characterized by Coronary Angiography. Arterioscler. Thromb. Vasc. Bio. 17: 33-37 [Abstract] [Full Text]  
• Wen Lieng Lee, , Chen, J.-W., Chi Woon Kong, , Jiann Jong Wang, , Ting, C.-T., Wan Leong Chan, , Wang, S.-P., Chang, M.-S. (1996). Changes in Cardiac Autonomic Activities in Patients with Syndrome X: A Study of Spectral Analysis of Heart Rate Variability. ANGIOLOGY 47: 929-939 [Abstract]  
• Egashira, K., Katsuda, Y., Mohri, M., Kuga, T., Tagawa, T., Kubota, T., Hirakawa, Y., Takeshita, A. (1996). Role of Endothelium-Derived Nitric Oxide in Coronary Vasodilatation Induced by Pacing Tachycardia in Humans. Circ. Res. 79: 331-335 [Abstract] [Full Text]  
• Egashira, K., Hirooka, Y., Kuga, T., Mohri, M., Takeshita, A. (1996). Effects of L-Arginine Supplementation on Endothelium-Dependent Coronary Vasodilation in Patients With Angina Pectoris and Normal Coronary Arteriograms. Circulation 94: 130-134 [Abstract] [Full Text]  
• Kadokami, T., Egashira, K., Kuwata, K., Fukumoto, Y., Kozai, T., Yasutake, H., Kuga, T., Shimokawa, H., Sueishi, K., Takeshita, A. (1996). Altered Serotonin Receptor Subtypes Mediate Coronary Microvascular Hyperreactivityin Pigs With Chronic Inhibitionof Nitric Oxide Synthesis. Circulation 94: 182-189 [Abstract] [Full Text]  
• Hashimoto, M., Akishita, M., Eto, M., Ishikawa, M., Kozaki, K., Toba, K., Sagara, Y., Taketani, Y., Orimo, H., Ouchi, Y. (1995). Modulation of Endothelium-Dependent Flow-Mediated Dilatation of the Brachial Artery by Sex and Menstrual Cycle. Circulation 92: 3431-3435 [Abstract] [Full Text]  
• Numaguchi, K., Egashira, K., Takemoto, M., Kadokami, T., Shimokawa, H., Sueishi, K., Takeshita, A. (1995). Chronic Inhibition of Nitric Oxide Synthesis Causes Coronary Microvascular Remodeling in Rats. Hypertension 26: 957-962 [Abstract] [Full Text]  
• Ito, A., Egashira, K., Kadokami, T., Fukumoto, Y., Takayanagi, T., Nakaike, R., Kuga, T., Sueishi, K., Shimokawa, H., Takeshita, A. (1995). Chronic Inhibition of Endothelium-Derived Nitric Oxide Synthesis Causes Coronary Microvascular Structural Changes and Hyperreactivity to Serotonin in Pigs. Circulation 92: 2636-2644 [Abstract] [Full Text]  
• Kovach, J. A., Gottdiener, J. S., Verrier, R. L. (1995). Vagal Modulation of Epicardial Coronary Artery Size in Dogs : A Two-Dimensional Intravascular Ultrasound Study. Circulation 92: 2291-2298 [Abstract] [Full Text]  
• Quyyumi, A. A., Dakak, N., Andrews, N. P., Gilligan, D. M., Panza, J. A., Cannon, R. O. III (1995). Contribution of Nitric Oxide to Metabolic Coronary Vasodilation in the Human Heart. Circulation 92: 320-326 [Abstract] [Full Text]  
• Kuga, T., Egashira, K., Mohri, M., Tsutsui, H., Harasawa, Y., Urabe, Y., Ando, S., Shimokawa, H., Takeshita, A. (1995). Bradykinin-Induced Vasodilation Is Impaired at the Atherosclerotic Site but Is Preserved at the Spastic Site of Human Coronary Arteries In Vivo. Circulation 92: 183-189 [Abstract] [Full Text]  
• Collins, P., Rosano, G. M. C., Sarrel, P. M., Ulrich, L., Adamopoulos, S., Beale, C. M., McNeill, J. G., Poole-Wilson, P. A. (1995). 17ß-Estradiol Attenuates Acetylcholine-Induced Coronary Arterial Constriction in Women but Not Men With Coronary Heart Disease. Circulation 92: 24-30 [Abstract] [Full Text]  
• Zeiher, A. M., Krause, T., Schachinger, V., Minners, J., Moser, E. (1995). Impaired Endothelium-Dependent Vasodilation of Coronary Resistance Vessels Is Associated With Exercise-Induced Myocardial Ischemia. Circulation 91: 2345-2352 [Abstract] [Full Text]  
• Egashira, K., Suzuki, S., Hirooka, Y., Kai, H., Sugimachi, M., Imaizumi, T., Takeshita, A. (1995). Impaired Endothelium-Dependent Vasodilation of Large Epicardial and Resistance Coronary Arteries in Patients With Essential Hypertension : Different Responses to Acetylcholine and Substance P. Hypertension 25: 201-206 [Abstract] [Full Text]  
• Bonnardeaux, A., Nadaud, S., Charru, A., Jeunemaitre, X., Corvol, P., Soubrier, F. (1995). Lack of Evidence for Linkage of the Endothelial Cell Nitric Oxide Synthase Gene to Essential Hypertension. Circulation 91: 96-102 [Abstract] [Full Text]  
• Rossen, J. D., Agmon, Y., Gorlin, R., Abbott, E.C., Egashira, K., Takeshita, A. (1993). Endothelial Dysfunction in Microvascular Angina. NEJM 329: 1739-1740 [Full Text]  
• Cannon, R. O. (1993). Chest Pain with Normal Coronary Angiograms. NEJM 328: 1706-1708 [Full Text]