Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of cor...Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provo-cation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina(VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm(intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.展开更多
INTRODUCTIONVasospastic angina （VSA） cardiac disorder that leads is an important functional to transient myocardial ischemia and is caused by sudden, intense and reversible coronary artery spasm resulting in subtota...INTRODUCTIONVasospastic angina （VSA） cardiac disorder that leads is an important functional to transient myocardial ischemia and is caused by sudden, intense and reversible coronary artery spasm resulting in subtotal or total occlusion.展开更多
BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes i...BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasm展开更多
Variant angina(VA)has been described the clinical entity whereby a sudden intense,spontaneous and reversible vasoconstriction of a coronary artery branch,subsequently resulted in subtotal or total occlusion during the...Variant angina(VA)has been described the clinical entity whereby a sudden intense,spontaneous and reversible vasoconstriction of a coronary artery branch,subsequently resulted in subtotal or total occlusion during the duration of attack or provocative test.It is used to appear frequently at rest in the absence of any augment of myocardial oxygen demand and associated with展开更多
BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear wheth...BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear whether intracoronary pressure differs between the two spasm types.AIM To investigate such relationships using a pressure wire during the spasm provocation test(SPT)in patients with VSA.METHODS Eighty-seven patients with VSA(average age:67 years;50 men,37 women)underwent SPT.During the SPT,a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery,and the ratio of the intracoronary pressure to the aortic pressure(Pd/Pa)was continuously monitored.An SPT was performed using acetylcholine(ACh),and the presence of coronary spasm was defined as the presence of>90%arterial narrowing in response to an ACh infusion,with the usual chest symptoms and/or ischemic ECG changes.Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification,while diffuse spasm was defined as>90%spasm with two or more segments.RESULTS Among 87 patients,the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group(n=33)than in the diffuse spasm group(n=54,P<0.05).In the vessel analyses,in these 134 spastic segments,diffuse and focal spasms were detected in 100 and 34 vessels,respectively.The Pd/Pa at baseline was similar in both groups(diffuse:0.96±0.05,focal:0.95±0.05,P=0.35);however,the Pd/Pa during coronary spasm was lower in focal spastic vessels(0.66±0.20)than in diffuse spastic vessels(0.76±0.11,P<0.01),and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels(-0.29±0.20)than in diffuse spastic vessels(-0.18±0.11,P<0.01).The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the intracoronary pressure during coronary sp展开更多
BACKGROUND We frequently encounter cases of women with vasospastic angina(VSA).Additionally,some women with VSA are younger than 60 years old.However,it is unknown whether the characteristics of VSA in women aged<6...BACKGROUND We frequently encounter cases of women with vasospastic angina(VSA).Additionally,some women with VSA are younger than 60 years old.However,it is unknown whether the characteristics of VSA in women aged<60 years are different from those in women aged≥60 years.AIM To investigate and compare the clinical characteristics and prognosis of VSA in women aged<60 years from those in women aged≥60 years.METHODS We enrolled 94 women with VSA who were diagnosed using the spasm provocation test.According to the age at diagnosis,the patients were divided into two groups:Group Y(age<60 years,n=17)and Group O(age≥60 years,n=77).Flow-mediated dilation(FMD)and nitroglycerin(NTG)-induced dilation(NID)of the brachial artery were performed and assessed using brachial ultrasonography.Moreover,conventional coronary risk factors,such as atherosclerotic lesions(stenosis>20%)detected using coronary angiography and focal spasms(coronary spasm within one segment of one coronary artery),and major cardiovascular adverse events(MACE)were assessed in both groups.RESULTS Smoking was more prevalent in Group Y than in Group O(P=0.04).FMD was similar in both groups(Group O:4.3%±3.2%,Group Y:4.5%±3.3%;P=0.75),whereas NID was higher in Group Y(20.5%±8.6%)than in Group O(13.6%±5.3%,P<0.01).Atherosclerosis was not detected in Group Y but was detected in Group O(61%,P<0.01).Focal spasms were less frequent in Group Y(12%)than in Group O(38%,P=0.04).The incidence of major adverse cardiac events did not differ between the two groups(P=0.40).CONCLUSIONWomen aged < 60 years with VSA have less atherosclerotic lesions and focal spasms. These characteristicsmay be affected by smoking habits and vascular smooth muscle dysfunction.展开更多
It is well known that calcium channel blockers(CCBs) are the first line of therapy for vasospastic angina(VSA). Here, we report two cases of VSA with an increase in the frequency of angina attacks after switching from...It is well known that calcium channel blockers(CCBs) are the first line of therapy for vasospastic angina(VSA). Here, we report two cases of VSA with an increase in the frequency of angina attacks after switching from a brand-name to a generic CCB. In both cases, angina recurred upon switching from a brand-name CCB to a generic CCB during follow-up. The patients' condition improved upon switching back to the original CCB. Both cases involved a high severity of VSA, based on the results of spasm provocation testing. These findings suggest that, in some patients with severe VSA, the frequency of angina attacks increases when switching from a brand-name CCB to a generic CCB. Cardiologists should consider this factor when prescribing drugs for angina.展开更多
Coronary artery vasospasm is an infrequent cause of acute coronary syndrome (ACS). A 50-year-old female developed persistent chest discomfort related to anterior STEMI. After an unsuccessful thrombolysis attempt, due ...Coronary artery vasospasm is an infrequent cause of acute coronary syndrome (ACS). A 50-year-old female developed persistent chest discomfort related to anterior STEMI. After an unsuccessful thrombolysis attempt, due to delay concern, the patient was then sent to the catheterization laboratory for rescue PCI. The coronary angiogram revealed a TIMI 3 flow proximal LAD significant stenosis with spastic appearance of the coronary arteries which has improved after intracoronary nitrates administration. Optical Coherence Tomography (OCT) excluded coronary artery dissection and haematoma also revealed thrombus on moderate atherosclerotic plaque. The patient was then pain-free;she was managed medically and discharged after few days of monitoring. Three weeks later, she developed transient chest pain with ST segment elevation while cycling during rehabilitation program. Provocation test by Ergonovine was positive with complete occlusion of proximal RCA (right coronary artery) complicated by transient complete heart block and shock. She was stabilized with 7 mg of intracoronary nitrates injection. She was discharged after close monitoring with calcium channel blocker and tobacco cessation. ACS may complicate prolonged coronary artery vasospasm making the diagnosis challenging. OCT may help understand ACS mechanism and exclude spontaneous coronary artery dissection. Provocation test is crucial for confirmation.展开更多
Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries.Pathophysiology of the disease remains incompletely un...Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries.Pathophysiology of the disease remains incompletely understood,with autonomic and endothelial dysfunction thought to play an important role.Due to the dynamic nature of the disease,its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female population.Cigarette smoking remains a prominent risk factor,although CAVS does not follow traditional coronary artery disease risk factors.Many triggers continue to be identified,with recent findings identifying chemotherapeutics,allergens,and inflammatory mediators as playing some role in the exacerbation of CAVS.Provocative testing with direct visualization is currently the gold-standard for diagnosis,but non-invasive tests,including the use of biomarkers,are being increasingly studied to aid in the diagnosis.Treatment of the CAVS is an area of active research.Apart from risk factor modification,calcium channel blockers are currently the first line treatment,with nitrates playing an important adjunct role.High-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator(ICD),although timing criteria for escalated therapy require further investigation.The role of pharmaceuticals targeting oxidative stress remains incompletely understood.展开更多
BACKGROUND Patients with vasospastic angina(VSA)sometimes experience prolonged chest symptoms.The clinical characteristics of these patients have not been clarified.AIM To investigate the clinical characteristics of p...BACKGROUND Patients with vasospastic angina(VSA)sometimes experience prolonged chest symptoms.The clinical characteristics of these patients have not been clarified.AIM To investigate the clinical characteristics of prolonged VSA patients.METHODS This study included 167 patients with VSA diagnosed by spasm provocation tests(SPTs)using acetylcholine,which recorded the frequencies of positive reactions to a low dose of acetylcholine(L-ACh),total occlusion due to spasm(TOC),focal spasm,and the unavoidable use of nitroglycerin(unavoidable-NTG)during SPTs.The patients underwent a medical interview that investigated the maximum duration and frequency of chest symptoms as well as the frequencies of variant angina and other serious symptoms.The patients were divided into two groups based on the maximal duration:The short-duration group(<15 min;n=114)and the long-duration group(≥15 min;n=53).They were also divided into two groups based on the frequency of chest symptoms:The low-frequency group(<4/mo;n=88)and the high-frequency group(≥4/mo;n=79).RESULTS The long-duration group showed higher frequencies of other serious symptoms(P<0.001)and variant angina(P<0.05)as well as higher frequencies of spasm induction by L-ACh(P<0.05),TOC(P<0.05),focal spasm(P<0.01),and unavoidable-NTG(P<0.01)than the short-duration group.These parameters did not differ significantly between the low-frequency and high-frequency groups.CONCLUSION These findings suggest that patients with VSA who experience prolonged chest symptoms may have more severe characteristics of VSA.展开更多
文摘Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provo-cation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina(VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm(intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.
文摘INTRODUCTIONVasospastic angina （VSA） cardiac disorder that leads is an important functional to transient myocardial ischemia and is caused by sudden, intense and reversible coronary artery spasm resulting in subtotal or total occlusion.
文摘BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasm
文摘Variant angina(VA)has been described the clinical entity whereby a sudden intense,spontaneous and reversible vasoconstriction of a coronary artery branch,subsequently resulted in subtotal or total occlusion during the duration of attack or provocative test.It is used to appear frequently at rest in the absence of any augment of myocardial oxygen demand and associated with
文摘BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear whether intracoronary pressure differs between the two spasm types.AIM To investigate such relationships using a pressure wire during the spasm provocation test(SPT)in patients with VSA.METHODS Eighty-seven patients with VSA(average age:67 years;50 men,37 women)underwent SPT.During the SPT,a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery,and the ratio of the intracoronary pressure to the aortic pressure(Pd/Pa)was continuously monitored.An SPT was performed using acetylcholine(ACh),and the presence of coronary spasm was defined as the presence of>90%arterial narrowing in response to an ACh infusion,with the usual chest symptoms and/or ischemic ECG changes.Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification,while diffuse spasm was defined as>90%spasm with two or more segments.RESULTS Among 87 patients,the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group(n=33)than in the diffuse spasm group(n=54,P<0.05).In the vessel analyses,in these 134 spastic segments,diffuse and focal spasms were detected in 100 and 34 vessels,respectively.The Pd/Pa at baseline was similar in both groups(diffuse:0.96±0.05,focal:0.95±0.05,P=0.35);however,the Pd/Pa during coronary spasm was lower in focal spastic vessels(0.66±0.20)than in diffuse spastic vessels(0.76±0.11,P<0.01),and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels(-0.29±0.20)than in diffuse spastic vessels(-0.18±0.11,P<0.01).The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the intracoronary pressure during coronary sp
文摘BACKGROUND We frequently encounter cases of women with vasospastic angina(VSA).Additionally,some women with VSA are younger than 60 years old.However,it is unknown whether the characteristics of VSA in women aged<60 years are different from those in women aged≥60 years.AIM To investigate and compare the clinical characteristics and prognosis of VSA in women aged<60 years from those in women aged≥60 years.METHODS We enrolled 94 women with VSA who were diagnosed using the spasm provocation test.According to the age at diagnosis,the patients were divided into two groups:Group Y(age<60 years,n=17)and Group O(age≥60 years,n=77).Flow-mediated dilation(FMD)and nitroglycerin(NTG)-induced dilation(NID)of the brachial artery were performed and assessed using brachial ultrasonography.Moreover,conventional coronary risk factors,such as atherosclerotic lesions(stenosis>20%)detected using coronary angiography and focal spasms(coronary spasm within one segment of one coronary artery),and major cardiovascular adverse events(MACE)were assessed in both groups.RESULTS Smoking was more prevalent in Group Y than in Group O(P=0.04).FMD was similar in both groups(Group O:4.3%±3.2%,Group Y:4.5%±3.3%;P=0.75),whereas NID was higher in Group Y(20.5%±8.6%)than in Group O(13.6%±5.3%,P<0.01).Atherosclerosis was not detected in Group Y but was detected in Group O(61%,P<0.01).Focal spasms were less frequent in Group Y(12%)than in Group O(38%,P=0.04).The incidence of major adverse cardiac events did not differ between the two groups(P=0.40).CONCLUSIONWomen aged < 60 years with VSA have less atherosclerotic lesions and focal spasms. These characteristicsmay be affected by smoking habits and vascular smooth muscle dysfunction.
文摘It is well known that calcium channel blockers(CCBs) are the first line of therapy for vasospastic angina(VSA). Here, we report two cases of VSA with an increase in the frequency of angina attacks after switching from a brand-name to a generic CCB. In both cases, angina recurred upon switching from a brand-name CCB to a generic CCB during follow-up. The patients' condition improved upon switching back to the original CCB. Both cases involved a high severity of VSA, based on the results of spasm provocation testing. These findings suggest that, in some patients with severe VSA, the frequency of angina attacks increases when switching from a brand-name CCB to a generic CCB. Cardiologists should consider this factor when prescribing drugs for angina.
文摘Coronary artery vasospasm is an infrequent cause of acute coronary syndrome (ACS). A 50-year-old female developed persistent chest discomfort related to anterior STEMI. After an unsuccessful thrombolysis attempt, due to delay concern, the patient was then sent to the catheterization laboratory for rescue PCI. The coronary angiogram revealed a TIMI 3 flow proximal LAD significant stenosis with spastic appearance of the coronary arteries which has improved after intracoronary nitrates administration. Optical Coherence Tomography (OCT) excluded coronary artery dissection and haematoma also revealed thrombus on moderate atherosclerotic plaque. The patient was then pain-free;she was managed medically and discharged after few days of monitoring. Three weeks later, she developed transient chest pain with ST segment elevation while cycling during rehabilitation program. Provocation test by Ergonovine was positive with complete occlusion of proximal RCA (right coronary artery) complicated by transient complete heart block and shock. She was stabilized with 7 mg of intracoronary nitrates injection. She was discharged after close monitoring with calcium channel blocker and tobacco cessation. ACS may complicate prolonged coronary artery vasospasm making the diagnosis challenging. OCT may help understand ACS mechanism and exclude spontaneous coronary artery dissection. Provocation test is crucial for confirmation.
文摘Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary arteries.Pathophysiology of the disease remains incompletely understood,with autonomic and endothelial dysfunction thought to play an important role.Due to the dynamic nature of the disease,its exact prevalence is not entirely clear but is found to be more prevalent in East Asian and female population.Cigarette smoking remains a prominent risk factor,although CAVS does not follow traditional coronary artery disease risk factors.Many triggers continue to be identified,with recent findings identifying chemotherapeutics,allergens,and inflammatory mediators as playing some role in the exacerbation of CAVS.Provocative testing with direct visualization is currently the gold-standard for diagnosis,but non-invasive tests,including the use of biomarkers,are being increasingly studied to aid in the diagnosis.Treatment of the CAVS is an area of active research.Apart from risk factor modification,calcium channel blockers are currently the first line treatment,with nitrates playing an important adjunct role.High-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator(ICD),although timing criteria for escalated therapy require further investigation.The role of pharmaceuticals targeting oxidative stress remains incompletely understood.
文摘BACKGROUND Patients with vasospastic angina(VSA)sometimes experience prolonged chest symptoms.The clinical characteristics of these patients have not been clarified.AIM To investigate the clinical characteristics of prolonged VSA patients.METHODS This study included 167 patients with VSA diagnosed by spasm provocation tests(SPTs)using acetylcholine,which recorded the frequencies of positive reactions to a low dose of acetylcholine(L-ACh),total occlusion due to spasm(TOC),focal spasm,and the unavoidable use of nitroglycerin(unavoidable-NTG)during SPTs.The patients underwent a medical interview that investigated the maximum duration and frequency of chest symptoms as well as the frequencies of variant angina and other serious symptoms.The patients were divided into two groups based on the maximal duration:The short-duration group(<15 min;n=114)and the long-duration group(≥15 min;n=53).They were also divided into two groups based on the frequency of chest symptoms:The low-frequency group(<4/mo;n=88)and the high-frequency group(≥4/mo;n=79).RESULTS The long-duration group showed higher frequencies of other serious symptoms(P<0.001)and variant angina(P<0.05)as well as higher frequencies of spasm induction by L-ACh(P<0.05),TOC(P<0.05),focal spasm(P<0.01),and unavoidable-NTG(P<0.01)than the short-duration group.These parameters did not differ significantly between the low-frequency and high-frequency groups.CONCLUSION These findings suggest that patients with VSA who experience prolonged chest symptoms may have more severe characteristics of VSA.
