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

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World Journal of Cardiology 2023年第1期15卷 1-12页

作者： hiroki teragawa Chikage Oshita Yuko Uchimura Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan

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 of>90%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 as>90%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,P<0.05).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,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 *** These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the

关键词： Acetylcholine Intracoronary pressure Diffuse or focal spasm Vasospastic angina

Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test?

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World Journal of Cardiology 2024年第1期16卷 16-26页

作者： hiroki teragawa Chikage Oshita Yuko Uchimura Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan

BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their *** To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the *** Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery *** 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 *** spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic *** 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,*** 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 *** who did not occur coronary spasms at any ACh dose were designated as group *** Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group *** 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

关键词： Acetylcholine Coronary spasm Intracoronary pressure Pressure wire Spasm provocation test Vasospastic angina

Vasospastic angina in women: Clinical backgrounds and prognoses of patients younger than and older than 60 years

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World Journal of Cardiology 2023年第4期15卷 154-164页

作者： hiroki teragawa Chikage Oshita Yuko Uchimura Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan

BACKGROUND We frequently encounter cases of women with vasospastic angina(VSA).Additionally,some women with VSA are younger than 60 years ***,it is unknown whether the characteristics of VSA in women aged20%)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 *** 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.

关键词： Acetylcholine Young female Smoking Vasospastic angina Vascular smooth muscle dysfunction

Primary malignant pericardial mesothelioma with difficult antemortem diagnosis:A case report

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World Journal of Clinical Cases 2022年第33期10卷 12380-12387页

作者： Naoya Oka Yuichi Orita Chikage Oshita Hirofumi Nakayama hiroki teragawa Department of Clinical Immunology and Rheumatology Hiroshima University HospitalHiroshima 734-8551Japan Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan Department of Pathology JR Hiroshima HospitalHiroshima 732-0057Japan

BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before *** present a case in which PMPM was diagnosed at *** consider this case to be highly suggestive and report it *** SUMMARY A 78-year-old male presented with transient loss of consciousness and *** transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial *** cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial *** considered pericardial disease to be the main pathogenesis of this *** magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the *** biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed *** noticed a thickening of the pericardium and massive changes in the pericardium on UCG over *** performed an autopsy 60 h after the patient died of *** staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of *** on these findings,the final diagnosis of PMPM was *** PMPM has a poor prognosis,and early diagnosis and treatment are *** temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.

关键词： Primary malignant pericardial mesothelioma Antemortem diagnosis Pericardial disease Temporal echocardiographic Case report

Primary aldosteronism due to bilateral micronodular hyperplasia and concomitant subclinical Cushing’s syndrome:A case report

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World Journal of Clinical Cases 2021年第5期9卷 1119-1126页

作者： hiroki teragawa Chikage Oshita Yuichi Orita Kunihiro Hashimoto Hirofumi Nakayama Yuto Yamazaki Hironobu Sasano Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan Department of Urology JR Hiroshima HospitalHiroshima 732-0057Japan Department of Pathology and Laboratory Medicine JR Hiroshima HospitalHiroshima 732-0057Japan Department of Pathology Tohoku University Graduate School of MedicineSendai 980-8574Japan

BACKGROUND Adrenal incidentaloma(AI)has been frequently encountered in the clinical *** has been shown that primary aldosteronism(PA)or subclinical Cushing’s syndrome(SCS)are the representative causative diseases of ***,the coexistence of PA and SCS has been reportedly ***,we encountered a case of AI,in which PA and SCS coexisted,confirmed by histopathological examinations after a laparoscopic *** believe that there were some clinical implications in the diagnosis of the present *** SUMMARY A 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg.A subsequent computed tomography scan revealed right ureterolithiasis,which was the cause of right abdominal pain,and right AI measuring 22 mm×25 *** the disappearance of right abdominal pain,subsequent endocrinological examinations were ***-related evaluations,including adrenal venous sampling,revealed the presence of bilateral *** addition,several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma.A laparoscopic right adrenalectomy was then *** histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma,while CYP11B2 immunoreactivity was absent in this ***,in the adjacent nonneoplastic adrenal,multiple CYP11B2-positive adrenocortical micronodules were detected,showing the presence of aldosterone-producing adrenocortical *** Careful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.

关键词： Primary aldosteronism Subclinical Cushing’s syndrome Adrenal incidentaloma Micronodular hyperplasia Case report

Coronary spasm: It's common, but it's still unsolved

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World Journal of Cardiology 2018年第11期10卷 201-209页

作者： hiroki teragawa Chikage Oshita Tomohiro Ueda Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan

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.

关键词： Vasospastic angina Medically refractory coronary spasm Variant angina Coronary vasospasm

Importance of a second spasm provocation test:Four cases with an initial negative spasm provocation test

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World Journal of Cardiology 2017年第3期9卷 289-295页

作者： hiroki teragawa Yuichi Fujii Yuko Uchimura Tomohiro Ueda Department of Cardiovascular Medicine JR Hiroshima HospitalHigashi-kuHiroshima 732-0057Japan

The spasm provocation test(SPT) is an important test in the diagnosis of vasospastic angina(VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negative. However, some patients continue to experience chest symptoms despite a negative SPT. In this study, we report four cases in which SPT was repeated to evaluate chest symptoms despite the negative results of the first SPT. Two men in their 70 s, one woman in her 60 s, and one woman in her 70 s, all with chest symptoms, underwent a second SPT at 4, 3, 2, and 3 years, respectively, after the first SPT, which was negative. Three patients had positive results in the second SPT(75%). In conclusion, even when SPT is negative, the diagnosis of VSA should be made with clinical symptoms in consideration. In some cases, a second SPT may be required to confirm the diagnosis of VSA.

关键词： Coronary spasm Acetylcholine Spasm provocation test Pressure wire

Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

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World Journal of Cardiology 2015年第6期7卷 367-372页

作者： hiroki teragawa Yuichi Fujii Tomohiro Ueda Daiki Murata Shuichi Nomura Department of Cardiovascular Medicine Hiroshima General Hospital of West Japan Railway Company

We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia,he was admitted to our institution for coronary angiography(CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery(LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm,which was relieved after the intracoronary infusion of nitroglycerin. Finally,a CAG showed myocardial bridging(MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77,which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus,coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia.

关键词： Coronary spasm Myocardial bridging Myocardial squeezing Fractional flow reserve

Positive influence of aspirin on coronary endothelial function: Importance of the dose

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World Journal of Cardiology 2013年第11期5卷 426-433页

作者： hiroki teragawa Naoya Mitsuba Ken Ishibashi Satoshi Kurisu Yasuki Kihara Department of Cardiovascular Medicine Hiroshima General Hospital of West Japan Railway Company Department of Cardiovascular Medicine Hiroshima University Graduate School of Biomedical Sciences

AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary arteries. Patients were distributed into GroupⅠ(n = 63), who was administered aspirin and Group Ⅱ(n = 76), the control, who were not administered aspirin. GroupⅠwas further divided into GroupⅠa(n = 50, low-dose aspirin, 100 mg) and GroupⅠb(n = 13, high-dose aspirin, 500 mg). After a routine coronary angiography, acetylcholine(ACh; 3 and 30 μg/min successively) and nitroglycerin(NTG) were infused into the left coronary ostium over 2 min. The change in the diameter of the coronary artery in response to each drug was expressed as the percentage change from baseline ***: The patient characteristics did not differ between the two groups. The change in coronary diameter in response to ACh was greater in GroupⅠthan in Group Ⅱ(P = 0.0043), although the NTG-induced coronary vasodilation was similar between groups. ACh-induced dilation was greater in GroupⅠa than in GroupⅠb(P = 0.0231). Multivariate regression analysis showed that a low-dose of aspirin(P = 0.0004) was one of the factors associated with ACh-induced dilation at 30 μg/***: In subjects with angiographically normal coronary arteries, aspirin only had a positive influence on coronary endothelial function at the low dose of 100 mg. This improvement of coronary endothelial function may be involved in the preventive effect of aspirin against future coronary events.

关键词： Acetylcholine Aspirin Coronary endothelial function Quantitative coronary angiography