Clinical significance of prolonged chest pain in vasospastic angina

Teragawa, Hiroki; Oshita, Chikage; Orita, Yuichi

doi:10.4330/wjc.v12.i9.450

Cited by 10 publications

(16 citation statements)

References 20 publications

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“…The left ventricular mass index (LVMI) was calculated using the formula of Devereux and Reichek [ 25 , 26 ]. As demonstrated previously [ 27 ], the flow-mediated dilation (FMD) and NTG-mediated dilation (NMD) of the brachial artery, which are objective measures of the endothelium-dependent and endothelium-nondependent functions, respectively, were evaluated using the UNEXEF device (UNEX Corp, Nagoya, Japan). Finally, peripheral endothelial function was measured via reactive hyperaemia peripheral artery tonometry (RH-PAT) using the Endo-PAT2000 device (Itamar Medical, Caesarea, Israel).…”

Section: Methodsmentioning

confidence: 99%

Coronary Microvascular Vasodilatory Function: Related Clinical Features and Differences According to the Different Coronary Arteries and Types of Coronary Spasm

Teragawa

Oshita

Uchimura

et al. 2021

JCM

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Background: In the clinical setting; the microvascular vasodilatory function test (MVFT) with a pressure wire has been used in ischaemia patients with non-obstructive coronary arteries (INOCA), including vasospastic angina (VSA) and microvascular angina (MVA). The exact factors that affect the microvascular vasodilatory function (MVF) in such patients are still unknown. We aimed to identify the factors, including clinical parameters and lesion characteristics, affecting the MVF in such patients. Methods: A total of 53 patients who underwent coronary angiography, spasm provocation tests (SPTs) and MVFTs were enrolled. In the MVFT, the coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were measured. Of the 53 patients, MVFT data in the left anterior descending coronary artery (LAD) were obtained from 49 patients, and the clinical parameters were checked in all of them. Based on the results of the SPT, coronary spasms were divided into focal spasm, diffuse spasm, and microvascular spasm (MVS). To assess the lesion characteristics influencing MVF, MVFT data were compared according to the types of coronary spasm and coronary vessels in 73 vessels of the 53 patients. Results: In 49 patients who underwent the MVFT in the LAD, the IMR was higher in active smokers (n = 7) than in former smokers (n = 15) and never smokers (n = 27, p < 0.01). In the 73 coronary arteries in this study, the type of coronary spasm did not correlate with the CFR or IMR, whereas a higher IMR were more frequently observed in cases of focal spasm than in cases of diffuse spasm (p = 0.03). In addition, the IMR was higher in the right coronary artery (RCA) than in the LAD (p = 0.02). Conclusion: These results indicate that the smoking status affected the MVF in patients with INOCA, suggesting the possibility of improvement in the MVF by smoking cessation in such patients. In addition, in the assessment of MVF, it may be important to take into account which coronary artery or types of coronary spasm are being evaluated.

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Section: Methodsmentioning

confidence: 99%

Coronary Microvascular Vasodilatory Function: Related Clinical Features and Differences According to the Different Coronary Arteries and Types of Coronary Spasm

Teragawa

Oshita

Uchimura

et al. 2021

JCM

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“…The kinds of adopted intracoronary modalities and/or the differences in the studied patients’ characteristics may contribute to the varied frequency of intracoronary thrombus formation. If patients with VA, a higher activity of VSA [ 22 , 32 ], were more frequently involved in the study, the frequency of intracoronary thrombus formation may have been higher, as shown in the study by Etsuda et al [ 10 ]. In the present study, under the condition that the spastic segments could be assessed using CAS, the frequency of intracoronary thrombus formation was 30% per patient and 26% per coronary artery, keeping with the results reported by others [ 10 , 11 , 12 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The patient was asked about current smoking status, and any family history of coronary artery disease was recorded. Hypertension, dyslipidaemia, diabetes mellitus and chronic kidney disease were defined based on the standard definitions described in previous papers [ 22 ]. Blood chemical parameters were monitored routinely using blood drawn in the morning on CAG.…”

Section: Methodsmentioning

confidence: 99%

Intracoronary Thrombogenicity in Patients with Vasospastic Angina: An Observation Using Coronary Angioscopy

et al. 2021

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Background: Despite significant interest in intracoronary thrombi in patients with vasospastic angina (VSA), the phenomenon remains unclarified. Therefore, we investigated a possible relationship using coronary angioscopy (CAS) in VSA patients. Methods: Sixty patients with VSA, for whom we could assess the spastic segment using CAS, were retrospectively studied. An intracoronary thrombus on CAS was a white thrombus and an erosion-like red thrombus. We verified the clinical characteristics and lesional characteristics as they determined the risk of intracoronary thrombus formation. Results: There were 18 (30%) patients with intracoronary thrombi. More of the patients with intracoronary thrombi were male, current smokers and had severe concomitant symptoms; however, no statistically significant difference was observed upon logistic regression analysis. There were 18 (26%) coronary arteries with intracoronary thrombi out of 70 coronary arteries recognised in the spastic segments. Furthermore, atherosclerotic changes and segmental spasms were significant factors responsible for such lesions. Conclusion: Intracoronary thrombi occurred in 30% of VSA patients and much attention should be paid to the intracoronary thrombogenicity of VSA patients.

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“…We conducted an SPT utilising the procedures previously published [ 15 ]. Briefly, 20 and 50 µg of acetylcholine (ACh) were injected into the RCA following the initial CAG.…”

Section: Methodsmentioning

confidence: 99%

“…Small dosages of catecholamines were administered intracoronary or intravenously if the patient’s haemodynamics remained unstable. Low doses of ACh (L-ACh) were used in this study, with the RCA and LCA receiving 20 µg and 50 µg, respectively [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Patients with Multi-Vessel Coronary Spasm in Comparison with Those in Patients with Single-Vessel Coronary Spasm

Teragawa

Oshita

Uchimura

2022

JCDD

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(1) Background: We have sometimes experienced patients with vasospastic angina (VSA) who presented multi-vessel spasm (MVS) on coronary angiography and spasm provocation test (SPT). However, the clinical characteristics of VSA patients with MVS and the prognosis of such patients in the clinical setting have not been clarified. Therefore, we compared the clinical characteristics and prognosis in VSA patients with MVS with those in VSA patients with single-vessel spasm (SVS). (2) Methods: A total of 152 patients (mean age, 67 years, 74 men and 78 women) with VSA, in which the presence of coronary spasm was assessed in both left coronary artery (LCA) and right coronary artery (RCA) on SPT, were enrolled. We defined VSA as the presence of >90% narrowing of the epicardial coronary artery on angiograms, accompanied by usual chest symptoms and/or ischaemic ST-T changes on the electrocardiogram. On SPT, MVS was defined as the presence of spasms on ≥2 major coronary arteries. Based on the presence of MVS, patients were divided into the MVS group and the SVS group. The frequencies of conventional coronary risk factors, blood chemical parameters, average times of anginal attack, SPT findings such as spasm provocation induced by a low dose of acetylcholine (L-ACh) and total occlusion due to coronary spasm (TOC), number of coronary vasodilators at discharge and major cardiovascular events (MACE, including cardiac death and readmission due to any cause of cardiovascular diseases) were compared between the two groups. (3) Results: The MVS and SVS groups were comprised of 98 (64%) and 54 (36%) patients, respectively. The level of fasting blood glucose (FBS) was lower (p < 0.01), and the level of cystatin-C (n = 89) tended to be higher (p = 0.07) in the MVS group than in the SVS group. The frequencies of L-ACh-induced coronary spasm (33% in MVS and 17% in SVS, p = 0.04) and TOC (12% in MVS, 0% in SVS, p < 0.01) were higher in the MVS group than in the SVS group. The average number of coronary vasodilators at discharge was higher in the MVS group (1.2 ± 0.4) than in the SVS group (0.9 ± 0.5, p < 0.01). The frequency of MACE was not different between the two groups. (4) Conclusions: Patients with MVS may have higher VSA activity on SPT and have more aggressive medications, leading to a comparable prognosis in VSA patients with SVS. MVS is an important indicator of at least VSA activity, and cardiologists should confirm this in SPT whenever possible. Further studies should confirm whether lower FBS levels and higher cystatin-C levels are any markers of MVS.

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Clinical significance of prolonged chest pain in vasospastic angina

Cited by 10 publications

References 20 publications

Coronary Microvascular Vasodilatory Function: Related Clinical Features and Differences According to the Different Coronary Arteries and Types of Coronary Spasm

Coronary Microvascular Vasodilatory Function: Related Clinical Features and Differences According to the Different Coronary Arteries and Types of Coronary Spasm

Intracoronary Thrombogenicity in Patients with Vasospastic Angina: An Observation Using Coronary Angioscopy

Clinical Characteristics and Prognosis of Patients with Multi-Vessel Coronary Spasm in Comparison with Those in Patients with Single-Vessel Coronary Spasm

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