Vasospastic angina: pathophysiology and clinical significance

Гельцер, Б. И.; Tsivanyuk, M. M.; Kotelnikov, V. N.; Карпов, Р. С.

doi:10.15829/1728-8800-2020-1-2391

Cited by 4 publications

(1 citation statement)

References 50 publications

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“…В то же время, антиоксиданты (витамины С, Е, глутатион) улучшают функцию эндотелия. Эстрогены также подавляют спазм КА (СКА) [6]. Точную причину вазоспазма выяснить не удалось.…”

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Vasospastic angina followed by acute coronary syndrome and myocardial infarction: a case report

Chepurnenko,

Shavkuta,

Chepurnenko

2024

Cardiovasc Ther Prev

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Introduction. One of the angina causes in intact coronary arteries may be vasospasm. Despite the stenosis absence, vasospastic angina is characterized by a recurrent course, can progress to myocardial infarction (MI) and cause life-threatening arrhythmias.Short description. A case of vasospastic angina in a 69-year-old man, confirmed by 24-hour electrocardiographic monitoring, is presented. Long-term vasospasm first led to acute coronary syndrome on November 11, 2022 without myocardial damage. Standard therapy is recommended. Calcium antagonists were not included in the prescriptions. Then, on December 23, 2022, frequent and longer-lasting attacks of angina with extensive irradiation and shortness of breath appeared. On December 29, 2022, acute MI developed. Both cardiovascular events were caused by vasospasm in the right coronary artery.Discussion. Currently, there is no exact data the frequency of vasospastic angina in Russia. There are no definitive guidelines regarding the rationale of endovascular intervention. High doses of calcium channel blockers are usually suggested. In case of insufficient effect of monotherapy, dihydropyridine and non-dihydropyridine calcium antagonists simultaneously or add long-acting nitrates should be used. Nicorandil is used as second-line drugs. The positive effect of statins has been proven. However, complete solution of the problem of recurrent MI against the background of vasospasm was not possible. The presented case highlights the recurrent nature of the disease and the importance of selecting optimal therapy aimed at preventing vasospasm in order to reduce the risk of myocardial damage in this category of patients.

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Section: Discussionunclassified

Vasospastic angina followed by acute coronary syndrome and myocardial infarction: a case report

Chepurnenko,

Shavkuta,

Chepurnenko

2024

Cardiovasc Ther Prev

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Electrocardiographic, echocardiographic and lipid parameters in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

et al. 2022

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Aim. To assess the predictive potential of electrocardiographic (ECG), echocardiographic, and lipid parameters for predicting obstructive coronary artery disease (oCAD) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) prior to invasive coronary angiography (CA).Material and methods. This prospective observational cohort study included 525 patients with NSTE-ACS with a median age of 62 years who underwent invasive coronary angiography. Two groups were distinguished, the first of which consisted of 351 (67%) patients with oCAD (stenosis 50%), and the second — 174 (33%) without oCAD (<50%). Clinical and functional status of patients before CAG was assessed by 40 indicators. Mann-Whitney, Fisher, chi-squared, univariate logistic regression (LR) methods were used for data processing and analysis, while miltivariate LR (MLR), gradient boosting (XGBoost) and artificial neural networks (ANN) were used to develop predictive models. The quality of the models was assessed using 4 following metrics: area under the ROC curve (AUC), sensitivity (Se), specificity (Sp), and accuracy (Ac).Results. A comprehensive analysis of ECG, echocardiography and lipid profile parameters made it possible to identify factors that had linear and non-linear association with oCAD. LR were used to determine their weight coefficients and threshold values with the highest predictive potential. The quality metrics of the best predictive algorithm based on MLR were 0,81 for AUC, 0,74 for Sp and Ac, and 0,75 for Se. The predictors of this model were 4 categorical parameters (left ventricular (LV) ejection fraction of 42-60%, global LV longitudinal systolic strain <19%, low-density lipoprotein cholesterol >3,5 mmol/l, age >55 years in men and >65 years for women).Conclusion. The prognostic model developed on the basis of MLR made it possible to verify oCAD with high accuracy in patients with NSTE-ACS before invasive CA. Models based on XGBoost and ANN had less predictive value.

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Parameters of complete blood count, lipid profile and their ratios in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

et al. 2022

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Aim. To evaluate the predictive potential of the parameters of complete blood count (CBC), lipid profile and their ratios for predicting obstructive coronary artery disease (oCAD) in patients with non-ST elevation acute coronary syndrome (NSTEACS).Material and methods. The study included 600 patients with NSTE-ACS with a median age of 62 years who underwent invasive coronary angiography (CA). Two groups were formed, the first of which consisted of 360 (60%) patients with oCAD (stenosis ≥50%), and the second — 240 (40%) with coronary stenosis <50%. The clinical and functional status of patients before CAG was assessed by 33 parameters, including parameters of CBC, lipid profile and their ratio. For statistical processing and data analysis, the Mann-Whitney, Fisher, chi-squared tests, univariate logistic regression (LR) were used, while for the creation of predictive models, multivariate LR (MLR) was used. The quality was assessed by 4 metrics: area under the ROC curve (AUC), sensitivity (Se), specificity (Sp), and accuracy (Ac).Results. CBC and lipid profile analysis made it possible to identify factors that are linearly and non-linearly associated with oCAD. Univariate LR revealed their threshold values with the highest predictive potential. The quality metrics of the best prognostic model developed using MLR were as follows: AUC — 0,80, Sp — 0,79, Ac — 0,76, Se — 0,78. Its predictors were 8 following categorical parameters: age >55 years in men and >65 years in women, lymphocyte count (LYM) <19%, hematocrit >49%, immune-inflammation index >1000, high density lipoprotein cholesterol (HDL-C) to low density lipoprotein cholesterol (LDL-C) ratio <0,3, monocyte (MON)-to-HDL-C ratio >0,8, neutrophil (NEUT)-to-HDL-C ratio >5,7 and NEUT/LYM >3. The relative contribution of individual predictors to the development of end point was determined.Conclusion. The predictive algorithm (model 9), developed on the basis of MLR, showed a better quality metrics ratio than other models. The following 3 factors had the dominant influence on the oCAD risk: HDL-C/LDL-C (38%), age of patients (31%), and MON/HDL-C (14%). The influence of other factors on the oCAD risk was less noticeable.

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Vasospastic angina: pathophysiology and clinical significance

Cited by 4 publications

References 50 publications

Vasospastic angina followed by acute coronary syndrome and myocardial infarction: a case report

Vasospastic angina followed by acute coronary syndrome and myocardial infarction: a case report

Electrocardiographic, echocardiographic and lipid parameters in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

Parameters of complete blood count, lipid profile and their ratios in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

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