Coronary Functional Abnormalities in Patients With Angina and Nonobstructive Coronary Artery Disease

Suda, Akira; Takahashi, Jun; Hao, Kun; Kikuchi, Yoku; Shindo, Tomohiko; Ikeda, Shohei; Sato, Kōichi; Sugisawa, Jun; Matsumoto, Yasuharu; Miyata, Satoshi; Sakata, Yasuhiko; Shimokawa, Hiroaki

doi:10.1016/j.jacc.2019.08.1056

Cited by 168 publications

(143 citation statements)

References 20 publications

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“…Epicardial coronary arteries without significant stenosis can contribute only about 5% of total coronary resistance, suggesting that coronary microvessels can play an important role in regulating myocardial blood flow [25]. The importance of microvascular function has been recognized because patients with impaired microvascular function had worse outcomes following cardiovascular events than those with normal microvascular function [76,[120][121][122][123].…”

Section: Significance Of Microvascular Spasm In Nonobstructive Coronamentioning

confidence: 99%

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

Kaikita

Yamamoto

Jinnouchi

et al. 2020

Cardiovasc Interv and Ther

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Coronary angiography (CAG) sometimes shows nonobstructive coronary arteries in patients with suspected angina or acute coronary syndrome (ACS). The high prevalence of nonobstructive coronary artery disease (CAD) in those patients has recently been reported not only in Japan but also in Western countries, and is clinically attracting attention. Coronary spasm is considered to be one of the leading causes of both suspected stable angina and ACS with nonobstructive coronary arteries. Coronary spasm could also be associated with left ventricular dysfunction leading to heart failure, which could be improved following the administration of calcium channel blockers. Because we rarely capture spontaneous attacks of coronary spasm with electrocardiograms or Holter recordings, an invasive diagnostic modality, acetylcholine (ACh) provocation test, can be useful in detecting coronary spasm during CAG. Furthermore, we can use the ACh-provocation test to identify high-risk patients with coronary spasm complicated with organic coronary stenosis, and then treat with intensive care. Nonobstructive CAD includes not only epicardial coronary spasm but also microvascular spasm or dysfunction that can be associated with recurrent anginal attacks and poor quality of life. ACh-provocation test could also be helpful for the assessment of microvascular spasm or dysfunction. We hope that cardiologists will increasingly perform ACh-provocation test to assess the pathophysiology of nonobstructive CAD.

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Section: Significance Of Microvascular Spasm In Nonobstructive Coronamentioning

confidence: 99%

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

Kaikita

Yamamoto

Jinnouchi

et al. 2020

Cardiovasc Interv and Ther

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“…Long-term prognosis of MVA patients has consistently been reported to be good [17] , a considerable number of patients with potential markers of worse outcome are included [12] , [13] . Of those, invasive physiological indices including CFR and IMR are considered to be predictive markers of adverse cardiac events in MVA patients [10] , [13] . In the present international study, we aim to elucidate the clinical characteristics and long-term prognosis of contemporary MVA patients in a large population in a prospective manner.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, tools for assessment of coronary microcirculation were not available until recently in clinical practice. Recently, however, several studies using both invasive and non-invasive techniques for assessment of coronary physiology have produced a large wealth of data, leading to a better understanding of CMD and microvascular ischemia [12] , [13] . Based on the recent discussions on the clinical implication of MVA due to CMD, the COronary VAsomotor Disorders International Study (COVADIS) group, which was established in 2012 by clinician scientists with expertise in coronary vasomotor abnormalities, proposed diagnostic criteria to define MVA [14] .…”

Section: Introductionmentioning

confidence: 99%

International prospective cohort study of microvascular angina – Rationale and design

Suda

Takahashi

Beltrame

et al. 2020

IJC Heart & Vasculature

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Background Patients with signs and symptoms of myocardial ischemia and non-obstructive coronary artery disease (CAD) frequently have coronary functional abnormalities, including coronary microvascular dysfunction. Those with the latter are grouped under the term “microvascular angina” (MVA). Although diagnostic criteria exist for MVA, as recently proposed by our COVADIS (COronary VAsomotor Disorders International Study) group and the condition has been increasingly recognized in clinical practice, the clinical characteristics and long-term prognosis of MVA patients in the current era remain to be fully elucidated. Aims In the present study, we aimed to prospectively assess the clinical characteristics and long-term prognosis of MVA subjects in the current era in an international, multicenter, observational, and prospective registry study. Methods A total of 15 medical centers across 7 countries (USA, UK, Germany, Spain, Italy, Australia, and Japan) enrolled subjects fulfilling the COVADIS diagnostic criteria for MVA as follows; (1) signs and/or symptoms of myocardial ischemia, (2) absence of obstructive CAD, and (3) objective evidence of myocardial ischemia and/or coronary microvascular dysfunction. The primary endpoint was the composite of major cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, hospitalization due to heart failure or unstable angina. Between July 2015 and December 2018, a total of 706 subjects with MVA (M/F 256/450, 61.1 ± 11.8 [SD] yrs.) were registered. Subjects will be followed for at least 1 year. Summary The present study will provide important information regarding the clinical characteristics, management, and long-term prognosis of MVA patients in the current era.

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“…Indeed, during spasm the oxygen supply to the myocardium is decreased, leading to myocardial ischemia and consequently anginal symptoms [11] . Frequently, microvascular spasm and reduced microvascular vasodilator capacity occur together [12] , [13] resulting in the occurrence of symptoms at rest and during exercise. The presence of CMD has been explained by an elevated shear stress to the vessels of the microvasculature, resulting from an increased LVEDP as well as LV hypertrophy [2] .…”

Section: Discussionmentioning

confidence: 99%

Coronary microvascular dysfunction in patients with mild-to-moderate aortic stenosis – Insights from intracoronary acetylcholine testing

Pereyra

Seitz

Mahrholdt

et al. 2020

IJC Heart & Vasculature

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Coronary Functional Abnormalities in Patients With Angina and Nonobstructive Coronary Artery Disease

Cited by 168 publications

References 20 publications

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

International prospective cohort study of microvascular angina – Rationale and design

Coronary microvascular dysfunction in patients with mild-to-moderate aortic stenosis – Insights from intracoronary acetylcholine testing

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