Association of Inflammation and Cytotoxin-Associated Gene A Positive Strains of Helicobacter Pylori in Cardiac Syndrome X

Background: Cardiac syndrome X (CSX) is a condition in which patients have the pain of angina despite normal coronary angiogram. Helicobacter pylori (H. pylori) infection causes chronic inflammation which may play a pathogenic role in CSX. We surveyed the association of inflammation with H. pylori and its virulent strain (cytotoxin-associated gene A positive; CagA+) infections with CSX. Material and Methods: Sixty patients with CSX (38 women/ 22 men; mean age: 51.8 +/- 12.3) and 60 age-and gender-matched healthy controls (39 women/ 21 men; mean age: 48.9 +/- 6.3) were enrolled. Plasma samples were tested for the presence of IgG antibody to H. pylori using enzyme linked immunosorbent assay (ELISA) method. IgG-positive patients were determined by the presence of IgG antibody to CagA, also by ELISA method. Also, plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-a) were measured by ELISA method. Results: Patients with CSX were detected to have significantly higher plasma IL-6 and TNF-alpha level in comparison with normal controls (33.6 +/- 3.5 vs 3.2 +/- 0.4 and 24.2 +/- 2.3 vs 3.1 +/- 0.4, respectively; p < 0.01). The plasma levels of these inflammatory factors in CgA+ were significantly higher than those in CagA) (CSX: IL-6: 43.05 +/- 5.04 vs 23.97 +/- 4.58 and TNF-a: 31.43 +/- 3.13 vs 16.47 +/- 2.93, Controls: IL-6: 3.52 +/- 1.39 vs 2.90 +/- 0.67 and TNF-a: 5.39 +/- 1.17 vs 2.22 +/- 0.43, respectively; p < 0.05). Conclusion: The CagA+ strain of H. pylori, can not only be a trigger, and may also have a role via chronic inflammation in the pathogenesis of CSX.