The Impact of Myocardial Bridging on the Coronary Functional Test in Patients with Ischaemia with Non-Obstructive Coronary Artery Disease

Teragawa, Hiroki; Oshita, Chikage; Uchimura, Yuko

doi:10.3390/life12101560

Cited by 9 publications

(9 citation statements)

References 46 publications

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“…Lesions with > 20% stenosis were defined as atherosclerotic. We also investigated the possibility of myocardial bridging (MB), which is the presence of a > 20% systolic reduction in coronary artery diameter[ 23 ]. Complications of CAG and SPT include common severe complications, such as myocardial infarction, cerebral infarction, vascular trauma requiring surgery associated with CAG, induction of coronary spasm or coronary perforation associated with a pressure wire insertion, ventricular fibrillation (Vf), pulseless ventricular tachycardia (pVT) or hemodynamic compromise requiring catecholamine administration, and atrial fibrillation associated with SPT.…”

Section: Methodsmentioning

confidence: 99%

Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

Teragawa¹,

Oshita²,

Uchimura³

2023

World J Cardiol

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BACKGROUND Several reports show that two types of coronary vasospasm (diffuse and focal spasm) are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina (VSA). It is unclear whether intracoronary pressure differs between the two spasm types. AIM To investigate such relationships using a pressure wire during the spasm provocation test (SPT) in patients with VSA. METHODS Eighty-seven patients with VSA (average age: 67 years; 50 men, 37 women) underwent SPT. During the SPT, a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery, and the ratio of the intracoronary pressure to the aortic pressure (Pd/Pa) was continuously monitored. An SPT was performed using acetylcholine (ACh), and the presence of coronary spasm was defined as the presence of > 90% arterial narrowing in response to an ACh infusion, with the usual chest symptoms and/or ischemic ECG changes. Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification, while diffuse spasm was defined as > 90% spasm with two or more segments. RESULTS Among 87 patients, the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group ( n = 33) than in the diffuse spasm group ( n = 54, P < 0.05). In the vessel analyses, in these 134 spastic segments, diffuse and focal spasms were detected in 100 and 34 vessels, respectively. The Pd/Pa at baseline was similar in both groups (diffuse: 0.96 ± 0.05, focal: 0.95 ± 0.05, P = 0.35); however, the Pd/Pa during coronary spasm was lower in focal spastic vessels (0.66 ± 0.20) than in diffuse spastic vessels (0.76 ± 0.11, P < 0.01), and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels (-0.29 ± 0.20) than in diffuse spastic vessels (-0.18 ± 0.11, P < 0.01). The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT. CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm, judging from the intracoronary pressure during coronary spasm.

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Section: Methodsmentioning

confidence: 99%

Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

Teragawa¹,

Oshita²,

Uchimura³

2023

World J Cardiol

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“…We conducted the SPT using the previously published procedures [ 11 , 12 , 13 , 14 ]. Briefly, in the SPT for the RCA, 20 and 50 µg ACh were injected into the RCA following the initial coronary angiogram (CAG).…”

Section: Methodsmentioning

confidence: 99%

“…Lesions with a stenosis of > 20% were classified as atherosclerotic lesions. Because MB has been associated with VSA [ 14 , 18 ], we examined MB, which was defined as a systolic constriction of the coronary artery diameter > 20% of the diastolic constriction. Variant angina (VA) was defined as angina with a spontaneous ST elevation on electrocardiogram (ECG).…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Patients with Vasospastic Angina Subjected to the Spasm Provocation Test and the Unavoidable Use of Nitroglycerin

Teragawa

Oshita

Uchimura

2023

JCDD

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Background: Multi-vessel spasm (MVS) has a prognostic impact in patients with vasospastic angina (VSA). Thus, the presence of coronary spasm in both the left coronary artery (LCA) and right coronary artery (RCA) should be assessed through the spasm provocation test (SPT). Nitroglycerin (NTG) is used to avoid SPT-related complications; however, this unavoidable use of NTG may decrease the detection of MVS. Therefore, we investigated the frequency of the unavoidable use of NTG during SPT and clarified the clinical characteristics in patients with VSA who underwent the unavoidable use of NTG during STP. Methods: A total of 141 patients with positive SPT were evaluated. A positive SPT was defined as > 90% constriction in epicardial coronary arteries in response to acetylcholine, accompanied by the usual chest symptoms and/or ischaemic ST-T changes on electrocardiography. When a coronary spasm occurred, we usually wait for the spontaneous relief of the coronary spasm. However, if a prolonged coronary spasm or unstable haemodynamics occurred, 0.3 mg NTG was administered intracoronarily to promptly relieve the coronary spasm and this was defined as the unavoidable use of NTG. Even when the unavoidable use of NTG was administered in one coronary artery, an additional SPT was performed on another coronary artery. If a coronary spasm occurred in another coronary artery, a positive SPT was diagnosed. In contrast, if a coronary spasm was not induced after the unavoidable use of NTG, the judgement was classified as undiagnosed. The patients were divided into two groups according to the unavoidable use of NTG: U-NTG (n = 42) and the final use of NTG: F-NTG (n = 99). The clinical characteristics and frequencies of MVS (≥2 major coronary arteries in which a coronary spasm was provoked) and complications (malignant arrhythmia and unstable haemodynamics requiring catecholamines) during the SPT were compared between the groups. Results: Except for smoking status, all other clinical characteristics did not differ significantly between the groups. More current smokers were observed in the U-NTG group (29%) than in the F-NTG group (12%, p = 0.02). The frequency of MVS did not vary significantly between the groups (p = 0.28), with 64% for U-NTG and 55% for F-NTG. No significant difference was found between the groups in the frequency of severe complications during SPT (p = 0.83), with 2% for U-NTG and 3% for F-NTG. In the U-NTG group, the positive induction rate of coronary spasm in another coronary artery was 40% (17/42). Conclusions: The unavoidable use of NTG occurred in ~30% of patients with VSA, most of whom were current smokers. It did not decrease the detection of MVS and potentially prevented severe complications during SPT. Therefore, the unavoidable use of NTG is acceptable during SPT. However, an additional test may need to be performed to assess the presence of MVS.

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“…Atherosclerotic lesions were defined as those with a stenosis > 20%. We also explored the likelihood of myocardial bridging (MB), which was defined as systolic reduction > 20% in the coronary artery diameter[ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Vasospastic angina in women: Clinical backgrounds and prognoses of patients younger than and older than 60 years

Teragawa¹,

Oshita²,

Uchimura³

2023

World J Cardiol

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BACKGROUND We frequently encounter cases of women with vasospastic angina (VSA). Additionally, some women with VSA are younger than 60 years old. However, it is unknown whether the characteristics of VSA in women aged < 60 years are different from those in women aged ≥ 60 years. AIM To investigate and compare the clinical characteristics and prognosis of VSA in women aged < 60 years from those in women aged ≥ 60 years. METHODS We enrolled 94 women with VSA who were diagnosed using the spasm provocation test. According to the age at diagnosis, the patients were divided into two groups: Group Y (age < 60 years, n = 17) and Group O (age ≥ 60 years, n = 77). Flow-mediated dilation (FMD) and nitroglycerin (NTG)-induced dilation (NID) of the brachial artery were performed and assessed using brachial ultrasonography. Moreover, conventional coronary risk factors, such as atherosclerotic lesions (stenosis > 20%) detected using coronary angiography and focal spasms (coronary spasm within one segment of one coronary artery), and major cardiovascular adverse events (MACE) were assessed in both groups. RESULTS Smoking was more prevalent in Group Y than in Group O ( P = 0.04). FMD was similar in both groups (Group O: 4.3% ± 3.2%, Group Y: 4.5% ± 3.3%; P = 0.75), whereas NID was higher in Group Y (20.5% ± 8.6%) than in Group O (13.6% ± 5.3%, P < 0.01). Atherosclerosis was not detected in Group Y but was detected in Group O (61%, P < 0.01). Focal spasms were less frequent in Group Y (12%) than in Group O (38%, P = 0.04). The incidence of major adverse cardiac events did not differ between the two groups (P = 0.40). CONCLUSION Women aged < 60 years with VSA have less atherosclerotic lesions and focal spasms. These characteristics may be affected by smoking habits and vascular smooth muscle dysfunction.

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The Impact of Myocardial Bridging on the Coronary Functional Test in Patients with Ischaemia with Non-Obstructive Coronary Artery Disease

Cited by 9 publications

References 46 publications

Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

Clinical Characteristics and Prognosis of Patients with Vasospastic Angina Subjected to the Spasm Provocation Test and the Unavoidable Use of Nitroglycerin

Vasospastic angina in women: Clinical backgrounds and prognoses of patients younger than and older than 60 years

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