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

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

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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

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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

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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

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