Ischemia With Nonobstructive Coronary Artery Disease

Hwang, Doyeon; Koo, Bon‐Kwon

doi:10.1016/j.jacasi.2023.01.004

Cited by 22 publications

(6 citation statements)

References 107 publications

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“…Heart failure patients with a lower ejection fraction tend to have a poorer prognosis [40]. The occurrence of angina is a typical manifestation of myocardial ischemia and is also a key node in determining cardiac function [41,42]. At this juncture, actively addressing the primary cardiac condition in patients may also have a positive impact on improving their liver function.…”

Section: Discussionmentioning

confidence: 99%

Causal Relationship between Angina and Hepatic Failure as Revealed by Mendelian Randomization

Xu,

Dirsch,

Dahmen

2024

JCM

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Background: Patients with angina are often suffering from comorbidities such as varying degrees of hepatic dysfunction. However, the impact of angina on the incidence of hepatic failure (HF) remains unclear. Methods: The genetic data were retrieved from genome-wide association studies. Five Mendelian randomization methods were used to investigate the causal relationship between unstable angina (UA), stable angina (SA), and HF. The result of the Inverse variance weighted (IVW) method was deemed the principal result. In addition, we performed a comprehensive sensitivity analysis to verify the robustness of the results. Results: The IVW results showed that UA (Odds ratio (OR): 2.055, 95% confidence interval (CI): 1.171–3.606, p = 0.012) was causally associated with the incidence of HF. SA (OR: 1.122, 95% CI: 0.738–1.706, p = 0.591) was not causally associated with the incidence of HF. Sensitivity analysis did not identify any bias in the results. Conclusions: UA turned out to be a risk factor for HF. SA does not have a significant causal effect on HF. Therefore, it is highly recommended that patients with chronic liver disease seek prompt medical attention and undergo regular monitoring of liver function when experiencing UA. This may help them to reduce the risk of HF.

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Section: Discussionmentioning

confidence: 99%

Causal Relationship between Angina and Hepatic Failure as Revealed by Mendelian Randomization

Xu,

Dirsch,

Dahmen

2024

JCM

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“…Spasms caused by ACh have been reported to be distal and diffuse, whereas those caused by ergonovine are proximal and focal. 25 The muscarinic ACh receptors (mAChRs) are important for vascular homeostasis. Their activation at the endothelial level leads to NO-mediated vasodilatation, whereas activation of mAChRs on the VSMCs causes vasoconstriction.…”

Section: Provocative Testingmentioning

confidence: 99%

Vasospastic angina: a review on diagnostic approach and management

Jenkins,

Pompei,

Ganzorig

et al. 2024

Therapeutic Advances in Cardiovascular Disease

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Vasospastic angina (VSA) refers to chest pain experienced as a consequence of myocardial ischaemia caused by epicardial coronary spasm, a sudden narrowing of the vessels responsible for an inadequate supply of blood and oxygen. Coronary artery spasm is a heterogeneous phenomenon that can occur in patients with non-obstructive coronary arteries and obstructive coronary artery disease, with transient spasm causing chest pain and persistent spasm potentially leading to acute myocardial infarction (MI). VSA was originally described as Prinzmetal angina or variant angina, classically presenting at rest, unlike most cases of angina (though in some patients, vasospasm may be triggered by exertion, emotional, mental or physical stress), and associated with transient electrocardiographic changes (transient ST-segment elevation, depression and/or T-wave changes). Ischaemia with non-obstructive coronary arteries (INOCA) is not a benign condition, as patients are at elevated risk of cardiovascular events including acute coronary syndrome, hospitalization due to heart failure, stroke and repeat cardiovascular procedures. INOCA patients also experience impaired quality of life and associated increased healthcare costs. VSA, an endotype of INOCA, is associated with major adverse events, including sudden cardiac death, acute MI and syncope, necessitating the study of the most effective treatment options currently available. The present literature review aims to summarize current data relating to the diagnosis and management of VSA and provide details on the sequence that treatment should follow.

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“…Recently, a growing recognition has emerged regarding patients who exhibit symptoms of myocardial ischemia but lack coronary artery obstruction ( 1 ). Microvascular angina is a prevalent symptomatic manifestation of transient myocardial ischemia and has been confirmed to result from microvascular dysfunction with nonobstructive coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

Ranolazine for improving coronary microvascular function in patients with nonobstructive coronary artery disease: a systematic review and meta-analysis with a trial sequential analysis of randomized controlled trials

Ling,

Fu,

et al. 2024

Quant Imaging Med Surg

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Background Microvascular dysfunction in patients with nonobstructive coronary artery disease is increasingly being recognized as an important health issue. This systematic review and meta-analysis evaluated the effectiveness of ranolazine, an antianginal agent, in improving coronary microvascular function. Methods We conducted a comprehensive literature search of the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, the Chinese BioMedical Literature Database, and gray literature databases until September 30, 2023. The included studies were randomized controlled trials (RCTs) published in the English or Chinese languages that screened for eligibility using two independent investigators. Risk of bias was evaluated with the Cochrane Collaboration tool. Subgroup and sensitivity analyses were used to identify sources of heterogeneity. Meta-analysis was performed using RevMan version 5.4 (Cochrane) and Stata version 16.0 (StataCorp). Results From 1,470 citations, 8 RCTs involving 379 participants were included in this analysis. Our findings showed that ranolazine increased coronary flow reserve (CFR) over an 8 to 12-week follow-up period [standardized mean difference =1.16; 95% confidence interval (CI): 0.4–1.89; P=0.002]. Ranolazine increased the global myocardial perfusion reserve index (MPRI) [weighted mean difference (WMD) =0.18; 95% CI: 0.07–0.29; P=0.002] and the midsubendocardial MPRI (WMD =0.10; 95% CI: 0.02–0.19; P=0.02). Moreover, ranolazine improved 3 of the 5 Seattle Angina Questionnaire scores, namely, physical functioning (WMD =4.89; 95% CI: 0.14 to 9.64; P=0.04), angina stability (WMD =17.31; 95% CI: 7.13–27.49; P=0.0009), and quality of life (WMD =10.11; 95% CI: 3.57–16.65; P=0.0003). Trial sequential analysis showed that the meta-analysis of angina stability and quality of life scores had a sufficient sample size and statistical power. Conclusions Our analysis suggests that ranolazine is associated with improvements in CFR, myocardial perfusion, and the Seattle Angina Questionnaire scores in patients with nonobstructive coronary artery disease. However, further large-scale RCTs with long-term follow-up are recommended to validate these findings and provide a more comprehensive understanding of the effects of ranolazine on coronary microvascular function.

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Ischemia With Nonobstructive Coronary Artery Disease

Cited by 22 publications

References 107 publications

Causal Relationship between Angina and Hepatic Failure as Revealed by Mendelian Randomization

Causal Relationship between Angina and Hepatic Failure as Revealed by Mendelian Randomization

Vasospastic angina: a review on diagnostic approach and management

Ranolazine for improving coronary microvascular function in patients with nonobstructive coronary artery disease: a systematic review and meta-analysis with a trial sequential analysis of randomized controlled trials

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