Coronary artery lumen complexity as a new marker for refractory symptoms in patients with vasospastic angina

Abstract

Refractory angina is an independent predictor of adverse events in patients with vasospastic angina (VSA). The aim of this study was to investigate the relationship between coronary lumen complexity and refractory symptoms in patients with VSA. Seventeen patients with VSA underwent optical coherence tomography. The patients were divided into the refractory VSA group (n = 9) and the stable VSA group (n = 8). A shoreline development index was used to assess the coronary artery lumen complexity. Shear stress was estimated using a computational fluid dynamics model. No difference was observed in the baseline characteristics between the two groups. The refractory VSA group showed the higher shoreline development index (refractory VSA 1.042 [1.017–1.188] vs stable VSA 1.003 [1.006–1.025], p = 0.036), and higher maximum medial thickness (refractory VSA 184 ± 17 μm vs stable VSA 148 ± 31 μm, p = 0.017), and higher maximum shear stress (refractory VSA 14.5 [12.1–18.8] Pa vs stable VSA 5.6 [3.0–10.5] Pa, p = 0.003). The shoreline development index positively correlates with shear stress (R2 = 0.46, P = 0.004). Increased medial thickness of the coronary arteries provokes lumen complexity and high shear stress, which might cause refractory symptoms in patients with VSA. The shoreline index could serve as a marker for irritability of the medial layer of coronary arteries and symptoms.

Prediction of Coronary Artery Disease using Artificial Intelligence – A Systematic Literature Review

“…If the overall score is less than 20, it is reasonable to believe that the ACS was caused by a CA spasm, and a spasm provocation test may be necessary. Tanaka, A et al, [92] have investigated how the intricacy of the coronary lumen correlates with refractory symptoms in vasospastic angina patients (VSA). Due to the increased medial thickness of the coronary artery, which results in lumen complexity and increases shear stress, patients with VSA may develop refractory symptoms.…”

The Role of Antiplatelet Therapy in Patients With MINOCA

“…However, endothelial dysfunction and vascular inflammation may also have a role in modulating this hyperreactivity ( 25 ). Some authors have proposed a link between episodes of coronary vasospasm and platelet activation ( 26 ). In particular, the rapid changes in local shear stress can potentially induce stabilized aggregation of the discoid platelets, resulting in the release of granules with vasoconstrictors.…”

Pathophysiology and Diagnosis of Coronary Functional Abnormalities

“…41 In particular, optical coherence tomography (OCT), which is a high-resolution imaging modality, is capable of visualising not only morphological features of coronary vascular wall but also adventitial vasa vasorum formation at the spasm site. 42,43 Chronic inflammatory changes in the coronary adventitia play important roles in the pathogenesis of coronary spasm through Rhokinase activation and resultant VSMC hypercontraction. 44 Indeed, OCTdelineated adventitial vasa vasorum formation was significantly enhanced at the spastic segments of VSA patients compared with those of control subjects.…”