The Preventive Effect of Magnesium on Coronary Spasm in Patients With Vasospastic Angina

Teragawa, Hiroki; Kato, Masaya; Yamagata, Togo; Matsuura, Hideo; Kajiyama, Goro

doi:10.1378/chest.118.6.1690

Cited by 65 publications

(48 citation statements)

References 24 publications

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“…14,15 Briefly, anti-anginal therapy was withheld for at least 48 h before cardiac catheterization, except for unrestricted use of sublingual nitroglycerin (NTG). Diagnostic right and left heart catheterization and coronary angiography were performed using the standard percutaneous femoral approach.…”

Section: Methodsmentioning

confidence: 99%

Tetrahydrobiopterin Improves Coronary Endothelial Function, But Does Not Prevent Coronary Spasm in Patients With Vasospastic Angina

Fukuda

Teragawa

Matsuda

et al. 2002

Circ J

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oronary spasm is believed to play an important role in the pathogenesis of vasospastic angina (VA) and can cause acute myocardial infarction or ischemic sudden death. 1 However, the precise pathophysiology of coronary spasm has yet to be elucidated, although coronary endothelial dysfunction is thought to be one of the mechanisms. 2,3 Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide (NO) synthase in both endothelial and vascular smooth muscle cells [4][5][6] and also serves as a scavenger of oxygen-derived free radicals, thereby decreasing NO breakdown. 7 Therefore, BH4 is considered essential for the regulation of NO bioavailability in endothelial cells and for the maintenance of cardiovascular homeostasis. In support of this concept, recent studies have shown that supplementation of BH4 improves impaired endothelial function in humans with various pathologic states, including hypercholesterolemia, smoking and coronary artery disease. [8][9][10][11] Because coronary endothelial dysfunction is commonly observed in patients with VA, 3,12,13 the depletion of BH4 and resultant reduction in NO bioavailability in the coronary circulation may be involved in the pathogenesis of coronary spasm. However, the effects of BH4 supplementation on coronary spasm have not been evaluated and so we investigated the effects of BH4 on the coronary vasoconstrictor response to acetylcholine (ACh) in patients with VA using quantitative coronary angiography. Methods Study PopulationWe enrolled 28 Japanese patients with VA (21 men, 7 women; mean age, 55 years; range, 38-70) who fulfilled the following inclusion criteria: (1) spontaneous chest pain associated with ST-segment elevation or depression at rest on 12-lead ECG or ambulatory ECG; (2) coronary spasm (≥50% reduction in arterial diameter during coronary angiography) in the left coronary artery associated with ST-segment changes and/or typical chest pain after intracoronary injection of ACh (Daiichi Pharmaceutical Co, Tokyo, Japan); and (3) no angiographic organic stenosis in the coronary arteries. Patients with severe left ventricular dysfunction and those with valvular heart disease were excluded. Written consent was obtained from each patient, and the protocol was approved by the Hiroshima University School of Medicine Ethics Committee. Study DesignThe study design has been described previously in detail. 14,15 Briefly, anti-anginal therapy was withheld for at least 48 h before cardiac catheterization, except for unrestricted use of sublingual nitroglycerin (NTG). Diagnostic right and left heart catheterization and coronary angiography were performed using the standard percutaneous femoral approach. A 6Fr guide catheter was introduced into the left main coronary artery, and a 5Fr temporary pacing electrode catheter (Bard, Tewksbury, MA, USA) was placed in the right ventricular apex via the right jugular vein and connected to a temporary pacemaker set at a rate of 50 beats/min. Study ProtocolAfter baseline conditions were established, incremental

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Section: Methodsmentioning

confidence: 99%

Tetrahydrobiopterin Improves Coronary Endothelial Function, But Does Not Prevent Coronary Spasm in Patients With Vasospastic Angina

Fukuda

Teragawa

Matsuda

et al. 2002

Circ J

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“…Response to ␤-blockade varies: in some, particularly in those with associated fixed lesions, a reduction in the frequency of exertion-induced angina is observed, but in others these drugs may be detrimental. 2 Magnesium deficiency is a possible factor contributing to CAS, and Teragawa and coworkers 9 suggested that its long-term supplementation might also have a preventive effect.…”

Section: Therapies Established and Newmentioning

confidence: 99%

Coronary Artery Spasm

2009

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“…After baseline conditions had been established, incremental doses of acetylcholine (Ach) were infused into the left coronary artery (3,30, and 100 µg/min) for 2 min, with 5-min intervals between consecutive doses until the induction of coronary spasm. Once coronary spasm was induced, the next infusion of Ach was withheld.…”

Section: Study Protocolmentioning

confidence: 99%

“…30 The length of the spastic segment was also defined as the length with a ≥ 50% reduction in diameter. The diameter of the totally occluded spastic segments was defined as 0 mm.…”

Section: Definitionsmentioning

confidence: 99%

Myocardial bridging increases the risk of coronary spasm

Teragawa

Fukuda

Matsuda

et al. 2003

Clinical Cardiology

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SummaryBackground: Myocardial bridging (MB) has been associated with cardiac events. Whether coronary spasm is one factor contributing to those events is unknown.Hypothesis: This study investigated whether the likelihood of coronary spasm is increased in patients with MB.Methods: A spasm-provocation test was performed by infusing acetylcholine into the left coronary artery in 114 Japanese patients with chest pain. The test result was defined as positive when the diameter of the coronary artery was reduced by ≥ 50% and ST-segment changes were documented. Myocardial bridging was defined as a > 15% reduction in coronary arterial diameter during systole after intracoronary injection of nitroglycerin.Results: Myocardial bridging was identified in 41 patients (36%) and was located in the mid-segment of the left anterior descending coronary artery (LAD) in all patients. Patients with MB experienced coronary spasm more frequently than patients without MB (MB+: 73%; MBϪ: 40%, p = 0.0006). Furthermore, among patients with a positive spasm-provocation test, coronary spasm occurred more frequently in the midsegment of the LAD in patients with MB than in those without MB (MB+: 73%; MBϪ: 45%, p = 0.0259). Multivariate regression analysis demonstrated that MB was a predictor of coronary spasm (odds ratio: 3.478, p = 0.0088).

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The Preventive Effect of Magnesium on Coronary Spasm in Patients With Vasospastic Angina

Cited by 65 publications

References 24 publications

Tetrahydrobiopterin Improves Coronary Endothelial Function, But Does Not Prevent Coronary Spasm in Patients With Vasospastic Angina

Tetrahydrobiopterin Improves Coronary Endothelial Function, But Does Not Prevent Coronary Spasm in Patients With Vasospastic Angina

Coronary Artery Spasm

Myocardial bridging increases the risk of coronary spasm

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