Combination of Variant and Microvascular Angina

Infusino, Fabio; Lanza, Gaetano Antonio; Sestito, Alfonso; Sgueglia, Gregory A.; Crea, Filippo; Maseri, Attilio

doi:10.1002/clc.20502

Cited by 12 publications

(6 citation statements)

References 26 publications

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“…Previous studies have shown that a reduced vasodilatory capacity of the coronary microcirculation can lead to exercise-induced angina in CSX [3] and recent observations indicate that some CSX patients may share features of Prinzmetal's variant angina [5,6]. In contrast, our study showed that distal and diffuse epicardial as well as increased microvascular constriction in response to acetylcholine can be an important pathogenic mechanism in patients with CSX.…”

Section: Discussioncontrasting

confidence: 81%

“…In the absence of coronary artery disease, coronary microvascular dysfunction, mainly abnormal vasodilation, has been proposed as a pathogenic mechanism in at least a proportion of patients [3,4]. However, recent clinical observations suggest that an increased coronary vasoconstrictor response may have a pathogenic role in CSX [5,6]. Moreover, studies have consistently shown that a proportion of CSX patients have not only exertional chest pain but also rest angina [7,8].…”

Section: Introductionmentioning

confidence: 98%

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Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)

et al. 2012

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Section: Discussioncontrasting

confidence: 81%

Section: Introductionmentioning

confidence: 98%

Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)

et al. 2012

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“…Of note, in agreement with these data, in 3 patients with typical VA, we have recently reported clinical evidence of the simultaneous occurrence of angina episodes typical of both VA and microvascular angina, suggesting that some common pathogenetic mechanisms may be responsible for clinical manifestations of both functional macro- and microvascular coronary artery abnormalities in some angina patients [26]. …”

Section: Discussionsupporting

confidence: 67%

Peripheral Arterial Function and Coronary Microvascular Function in Patients with Variant Angina

et al. 2014

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Objectives: In this study, we assessed whether any abnormalities in coronary microvascular and peripheral vasodilator functions are present in patients with variant angina (VA) caused by epicardial coronary artery spasm (CAS). Methods: We studied 23 patients with VA (i.e. angina at rest, ST-segment elevation during angina attacks and documented occlusive CAS at angiography) and 18 matched healthy controls. Endothelium-dependent and -independent coronary microvascular function was assessed by measuring coronary blood flow (CBF) response to adenosine and the cold pressor test (CPT) in the left anterior descending artery by transthoracic Doppler echocardiography. Systemic endothelium-dependent and -independent arterial dilator function was assessed by measuring brachial flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD), respectively. Results: In VA patients, CBF responses to both adenosine (1.71 ± 0.25 vs. 2.97 ± 0.80, p < 0.01) and CPT (1.68 ± 0.23 vs. 2.58 ± 0.60, p < 0.01) were reduced compared to controls. Brachial FMD was also lower (3.87 ± 2.06 vs. 8.51 ± 2.95%, p < 0.01), but NMD was higher (16.7 ± 1.8 vs. 11.9 ± 1.4%, p < 0.01) in patients compared to controls. Differences were independent of the presence of coronary atherosclerotic lesions at angiography. Conclusions: Our data show that patients with VA have a generalized vascular dysfunction that involves both peripheral artery vessels and coronary microcirculation.

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“…In some patients, spasm may even be present in the coronary epicardial arteries as well as in the microvessels. 8 Anatomically, epicardial coronary spasm is defined as focal if it is confined within the borders of a coronary segment according to the 16 segment coronary model of the American Heart Association. 9 Diffuse spasm is present if adjacent coronary segments are involved.…”

Section: Definition and Pathophysiology Of Coronary Artery Spasmmentioning

confidence: 99%

Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris

Ong

Aziz

Hansen

et al. 2015

Circ J

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Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical coherence tomography have been applied to study the coronary pathology in patients with vasospastic angina. Patients with vasospastic angina represent a heterogeneous cohort of patients with regard to the extent of concomitant coronary atherosclerosis. They share the common pathophysiological phenomenon of vascular smooth muscle hyperreactivity leading to spasm caused by various factors that may also overlap. Focal coronary spasm is related to epicardial atherosclerosis and in the presence of obstructive coronary artery disease it may be useful to treat the lesion to prevent further spasm. The aim of this article is to review structural and functional coronary artery abnormalities in patients with vasospastic angina. (Circ J 2015; 79: 1431 -1438

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Combination of Variant and Microvascular Angina

Cited by 12 publications

References 26 publications

Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)

Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)

Peripheral Arterial Function and Coronary Microvascular Function in Patients with Variant Angina

Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris

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