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

Abstract

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 types. AIM To investigate such relationships using a pressure wire during the spasm provocation test (SPT) in patients with VSA. METHODS Eighty-seven patients with VSA (average age: 67 years; 50 men, 37 women) underwent SPT. During 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 monitored. An 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 changes. Focal 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 segments. RESULTS 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, respectively. The 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 SPT. CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm, judging from the intracoronary pressure during coronary spasm.

Clinical Characteristics and Major Adverse Cardiovascular Events in Diabetic and Non-Diabetic Patients with Vasospastic Angina

“… 33 However, the definition of focal spasm employed may lead to differences in interpretation. 28 In this study, the frequency of atherosclerotic lesions was increased by DM complications; however, focal spasm was rather unlikely to occur. Furthermore, our results suggest that focal spasm may have a poor prognosis when complicated with DM, even though it tends to be less common, and this finding might be noteworthy.…”

“… 9 , 22 This study’s findings also corroborate the fact that VSA patients with focal spasm have a poorer prognosis than those with diffuse spasm. Possible explanations for poorer prognosis with focal spasm include the fact that the degree of ischemia at the time of spasm is greater in focal spasm than in diffuse spasm, 28 as well as the presence or formation of unstable atherosclerotic lesions at the site of focal spasm. 23 , 37 Furthermore, unstable atherosclerotic lesions may exist or form at the site of the focal spasm, possibly with unstable plaques, such as yellowish or thrombosed lesions on coronary angioscopy 24 , 25 , 38 and thrombus formation or intraplaque hemorrhage on optical coherence tomography.…”

“…Myocardial bridging (MB) was defined as a contraction of systolic coronary artery diameter by >20% compared with the diastolic diameter. 28 …”

“… 14 As previously reported, 26 the estimated glomerular filtration rate (eGFR) and the presence of chronic kidney disease (CKD) were determined, and the presence of metabolic syndrome (MtS) was also checked. As previously reported, 28 the left ventricular ejection fraction (LVEF) was determined by echocardiography (UCG) using the modified Simpson method, and flow-mediated dilation (FMD) and nitroglycerin-induced dilation (NID) of the brachial artery were determined.…”

Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders

“…Intracoronary imaging studies revealed that atherosclerotic plaques in focal spastic segments exhibit often vulnerable features, such as high lipid content, macrophage infiltration, intraplaque neovessels and intracoronary thrombi, predisposing to destabilization [ 108 ]. Furthermore Teragawa et al postulated that CAS contributes to thrombogenicity [ 109 ]. This finding might explain the worse prognosis observed in patients with focal compared to diffuse CAS [ 82 ].…”