Periarteritis of Coronary Arteries with Severe Eosinophilic Infiltration

Kajihara, Hiroki; Kato, Yasuko; Takanashi, Atsushi; Nakagawa, Hiroshi; Tahara, Eiichi; Otsuki, Takahiko; Tsuchioka, Yukiko; Amioka, Hideyo; Okamoto, Masahiro; Matsuura, Hiroo; Kajiyama, Goro

doi:10.1016/s0344-0338(88)80190-0

Cited by 24 publications

(17 citation statements)

References 13 publications

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“…No other type of vasculitis could be found in other organs or tissues. These findings are similar to those of the first case of ECPA reported in 1989 [8]. As a result, they considered isolated ECPA to be a new disease entity rather than a variant form of AGA or CSS, as reported by Lie and Bayardo [9].…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Eosinophilic Coronary Periarteritis: A New Type of Coronary Arteritis as a Cause of Vasospastic Angina and Sudden Death

Kajihara¹

2012

J Clin Exp Cardiolog

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Eosinophilic coronary periarteritis (ECPA) has been recently established as a new pathological entity and clinically showed a vasospastic angina and sudden cardiac death (SCD). The patients were relatively young (mainly 30 to 50 years old) and predominantly male. The characteristic clinical findings of this disease include a) vasospastic angina (Prinzmetal's variant angina) appearing usually from evening to early in the morning, b) all patients experienced SCD early in the morning, and c) allergy or history of allergy was hard to identify in the patients with this disease. Histological findings include a) eosinophilic inflammatory infiltration limited to the adventitia and periadventitial soft issue is recognized in the epicardial large coronary arteries, b) all 3 main coronary artery branches are affected, with the left anterior descending artery most frequently affected, c) medial smooth muscle cells of the affected coronary artery and both internal and elastic laminae are well preserved, d) fibrinoid necrosis or granuloma as seen in polyarteritis nodosa or allergic granulomatous angina are not found in or around the inflammatory area, and e) no findings of any type of vasculitis in any other tissues or organs (i.e., localized or non-systemic periarteritis). Spontaneous coronary artery dissection (SCAD) is frequently accompanied by eosinophilic inflammatory infiltration limited to the adventitia and periadventitial soft issue in the dissected portion of the epicardial coronary arteries, i.e., same as the findings of ECPA, and the patients usually die suddenly.A considerable number of patients with this disease will be included among patients suffering from vasospastic angina. Therefore, it is very important for cardiologists to make a precise diagnosis of and provide adequate treatment for this disease.

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Section: Discussionsupporting

confidence: 88%

“…In 1989, Kajihara et al [8] reported the first case of ECPA. In the same year, Lie and Bayardo reported the case of a 39-year-old man who had complained of intermittent chest pain during the preceding week and was found dead in the morning in his living room (sudden unexpected death) [9].…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Coronary Periarteritis: A New Type of Coronary Arteritis as a Cause of Vasospastic Angina and Sudden Death

Kajihara¹

2012

J Clin Exp Cardiolog

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“…Kajihara [12] and Omoto [22] showed eosinophilic infiltration around vasa vasorum and nerve fibres, and stimulation of nerve fibres in the adventia is another possible explanation for coronary vasospasm. Eosinophils also cause tissue destruction which predisposes to dissection [27][28][29], aneurysmal dilation [15] and thrombosis [6,17], and later fibrosis of the intima and media of the coronary artery wall [12,23] Multi-focal coronary involvement was common. The high prevalence of asthma and the temporal association between asthma and angina suggest eosinophils can provoke smooth muscle constriction in both coronary arteries and bronchi [31].…”

Section: Discussionmentioning

confidence: 97%

“…There was no eosinophilic infiltration of other coronary segments, the myocardium or other organs. For the case by Kajihara [12], intimal fibrosis and eosinophilic infiltration of the adventitia involved multiple segments of large coronary arteries. There were also multiple areas of sub-endocardial fibrosis consistent with previous myocardial infarction.…”

Section: Post-mortem Findingsmentioning

confidence: 99%

Eosinophilia and Coronary Artery Vasospasm

Wong

Luis

Zeng

et al. 2008

Heart, Lung and Circulation

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“…[2][3][4] We postulate that this cause should also be considered in this athlete. Kajihara et al 5 provide a recent review on this topic, and it is noted that the vasospastic angina is most common overnight, or in the early morning, as was the case here.…”

mentioning

confidence: 92%

Letter by McGorrian et al Regarding Article, “A Shocking Development in a Young Male Athlete With Chest Pain”

2016

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We read with interest the case presented by Alexander and colleagues 1 describing episodes of chest tightness in a healthy endurance athlete, with subsequent findings of coronary vasospasm, with polymorphic ventricular tachycardia in the setting of spasm events, and an aborted sudden death event with ventricular tachycardia. We note that the patient was known to have seasonal allergic rhinitis and a history of childhood asthma, and was an occasional user of cetirizine/pseudoephedrine.There is a recognized phenomenon of sudden death in association with coronary eosinophilic periarteritis, and although the literature focuses on coronary dissection as the key sequel, sudden cardiac death in the absence of dissection has been recognized. [2][3][4] We postulate that this cause should also be considered in this athlete. Kajihara et al 5 provide a recent review on this topic, and it is noted that the vasospastic angina is most common overnight, or in the early morning, as was the case here. Although a history of asthma or atopy is not consistently present in the case reports, this remains a potential pointer as to the underlying pathogenesis. DisclosuresNone. AFFiliATioNFrom Department of Cardiology and University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.

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Periarteritis of Coronary Arteries with Severe Eosinophilic Infiltration

Cited by 24 publications

References 13 publications

Eosinophilic Coronary Periarteritis: A New Type of Coronary Arteritis as a Cause of Vasospastic Angina and Sudden Death

Eosinophilic Coronary Periarteritis: A New Type of Coronary Arteritis as a Cause of Vasospastic Angina and Sudden Death

Eosinophilia and Coronary Artery Vasospasm

Letter by McGorrian et al Regarding Article, “A Shocking Development in a Young Male Athlete With Chest Pain”

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