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Clinical significance of prolonged chest pain in vasospastic angina

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World Journal of Cardiology 2020年第9期12卷 450-459页

作者： Hiroki Teragawa Chikage Oshita Yuichi Orita Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan

BACKGROUND Patients with vasospastic angina(VSA)sometimes experience prolonged chest *** clinical characteristics of these patients have not been *** To investigate the clinical characteristics of prolonged VSA *** 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 *** 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 *** patients were divided into two groups based on the maximal duration:The short-duration group(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 *** parameters did not differ significantly between the low-frequency and high-frequency *** These findings suggest that patients with VSA who experience prolonged chest symptoms may have more severe characteristics of VSA.

关键词： Acetylcholine Prolonged angina attacks Variant angina vasospastic angina Spasm provocation test Prognosis

Association of dyslipidemia with vasospastic angina

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Chinese Medical Journal 2014年第7期127卷 1370-1376页

作者： Hong Lifeng Luo Songhui Li Jianjun Division of Dyslipidemia State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Peking Union Medical College Beijing 100037 China Divison of Cardiology Guangci Hospital affiliated Medical College of Wuhan University & the Fifth Hospital of Wuhan Wuhan Hubei 430050 China

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 *** is used to appear frequently at rest in the absence of any augment of myocardial oxygen demand and associated with

关键词： vasospastic angina dyslipidemia therapy

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

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

Coronary vasospasm:A narrative review

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World Journal of Cardiology 2021年第9期13卷 456-463页

作者： Jacob Jewulski Sumesh Khanal Khagendra Dahal Foundational Medical Studies Oakland University William Beaumont School of MedicineRochesterMI 48309United States Department of Internal Medicine William Beaumont HospitalRoyal OakMI 48073United States Department of Cardiology CHI HealthCreighton University School of MedicineOmahaNE 68118United States

Coronary artery vasospasm(CAVS)plays an important role in acute chest pain syndrome caused by transient and partial or complete occlusion of the coronary *** of the disease remains incompletely understood,with autonomic and endothelial dysfunction thought to play an important *** 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 *** smoking remains a prominent risk factor,although CAVS does not follow traditional coronary artery disease risk *** triggers continue to be identified,with recent findings identifying chemotherapeutics,allergens,and inflammatory mediators as playing some role in the exacerbation of *** 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 *** of the CAVS is an area of active *** from risk factor modification,calcium channel blockers are currently the first line treatment,with nitrates playing an important adjunct ***-risk patients with life-threatening complications should be considered for implantable cardioverter defibrillator(ICD),although timing criteria for escalated therapy require further *** role of pharmaceuticals targeting oxidative stress remains incompletely understood.

关键词： Coronary artery vasospasm vasospastic angina Prinzmetal angina Variant angina Coronary artery disease

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