Does the intracoronary pressure differ according to two types(diffuse or focal)of coronary spasm?

作     者：Hiroki Teragawa Chikage Oshita Yuko Uchimura 

作者机构：Department of Cardiovascular MedicineJR Hiroshima HospitalHiroshima 732-0057Japan 

出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)

年 卷 期：2023年第15卷第1期

页      面：1-12页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Acetylcholine Intracoronary pressure Diffuse or focal spasm Vasospastic angina 

摘      要：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 *** To investigate such relationships using a pressure wire during the spasm provocation test(SPT)in patients with *** Eighty-seven patients with VSA(average age:67 years;50 men,37 women)underwent *** 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 *** SPT was performed using acetylcholine(ACh),and the presence of coronary spasm was defined as the presence of90%arterial narrowing in response to an ACh infusion,with the usual chest symptoms and/or ischemic ECG *** spasm was defined as total or subtotal spasm within one segment of the AHA classification,while diffuse spasm was defined as90%spasm with two or more *** 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,P0.05).In the vessel analyses,in these 134 spastic segments,diffuse and focal spasms were detected in 100 and 34 vessels,*** 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,P0.01),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,P0.01).The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during *** These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the