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393 EVIDENCE OF HYPOXIC NEUROVASCULAR CORONARY INJURY IN FIBROMYALGIA
  1. A. Cho,
  2. R. Barndt
  1. Los Angeles, CA.

Abstract

Our pilot studies (PS) in fibromyalgia (Fibro) show that coronary artery (CA) stenoses (CS) occurs without traditional risk factors (RF). Ultrasonic measurements (UM) with image processing enable studies of aortic collagen (AC), %CS and % cardiac muscle collagen (%CMC) by methods previously reported by our clinic. Neurovascular tone (NVT) was found abnormally high in all PS Fibro cases measured by systolic time intervals (STI=PEP/ LVET X 100%). The abnormal NVT was associated with significant (Sig*) (P≤0.01) elevation of systemic vascular resistance (SVR) ≥age matched control group (CG). PS show %CMC increases with %CS. Severe %CMC caused a restrictive cardiomyopathy. Prospective studies (ProS) were done with a random sample of patients from the general population with classical Fibro by the criteria of the American College of Rheumatology for 3 -14 years (all Cauc., f/m 2/1, age 13-65). Exclusions were all traditional RF: SBP≥125, LDL≥130, HgA1C≥6, smokers, and high sed rate. UM were made without clinical facts and data was placed into a blind matrix. %CS was measured by UM predictive of angiographic findings in previous studies (R=0.96, P≤0.01). PS end diastolic volume (EDV cc/M2) criteria were used to place people into G1 (EDV≥40cc/M2) or G2 (≤40cc/M2). G analysis: G means are shown. (Table)

Where: *=Sig* difference from CG at P≤0.01 by T test. CO = cardiac output, L/min. SVR=dynes.sec.cm-5. LA = left atrial diameter in mm. %RCS = Right CA stenosis. %Circ.S = circumflex stenosis. %LADS = left anterior discending stenosis. QL = quality of life (0-100), and T = Time (duration of Fibro in yrs). In ProS, %CS was predicted by STI and time using PS equations (R=0.97, P≤0.01) without other Sig* RF by multivariant analysis. High NVT (low STI) was the Sig RF (R2=0.94) in CS. A pattern of CA damage was seen with greater %CS in the larger RCA (≥Circ ≥LAD) in all cases, as in PS, suggesting a chronic wall tension-hypoxic CA injury due to high NVT. G2 shows greater %CMC with greater %CS and duration of Fibro than G1. Restrictive cardiomyopathy was found in all G2 cases (Sig* ≥%CMC, Sig* ≤EDV, Sig* ≤CO versus GC). This is the first study to report evidence supporting hypoxic injury due to high NVT as a mechanism of CA and cardiac muscle injury in fibromyalgia.

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