Change of coronary flow velocity during the cold pressor test is related to endothelial markers in subjects with chest pain and a normal coronary angiogram

Acute Myocardial Injury and Complete Atrioventricular Block Induced by Transient Coronary Artery Spasm

A 65-year-old man with no previous history of heart disease presented with cardiogenic shock. Acute right ventricular failure following extensive inferior wall myocardial infarction and complete atrioventricular block were noted and emergent angiography revealed insignificant coronary arterial stenosis. In view of the finding and absence of myocardial vasculitis, coronary artery spasm was implicated as the cause of myocardial infarction and complete atrioventricular block. After the reversal of the shock and successful angioplasty, the patient continued to take lercanidipine and had been angina-free during follow-up of 5 months. (Hong Kong j.emerg.med. 2013;20:396-399)

Acute Myocardial Injury and Complete Atrioventricular Block Induced by Transient Coronary Artery Spasm

A 65-year-old man with no previous history of heart disease presented with cardiogenic shock. Acute right ventricular failure following extensive inferior wall myocardial infarction and complete atrioventricular block were noted and emergent angiography revealed insignificant coronary arterial stenosis. In view of the finding and absence of myocardial vasculitis, coronary artery spasm was implicated as the cause of myocardial infarction and complete atrioventricular block. After the reversal of the shock and successful angioplasty, the patient continued to take lercanidipine and had been angina-free during follow-up of 5 months. (Hong Kong j.emerg.med. 2013;20:396-399)

Secondary prevention strategy of cardiovascular disease using endothelial function testing

Over the past decades, secondary prevention of cardiovascular (CV) disease has improved and considerably reduced mortality rates. However, there remains a high-rate of new or recurrent CV events in those with established atherosclerotic vascular diseases. Although most of the prevailing therapies target the conventional risk factors, there is notable interindividual heterogeneity in adaptation to risk factors and response to therapies, which affects efficacy. It is desirable to have a methodology for directly assessing the functional significance of atherogenesis, and for managing individual patients based on their comprehensive vascular health. Endothelial function plays a pivotal role in all stages of atherosclerosis, from initiation to atherothrombotic complication. Endothelial function reflects the integrated effect of all the atherogenic and atheroprotective factors present in an individual, and is therefore regarded as an index of active disease process and a significant risk factor for future CV events. Moreover, improvement in endothelial function is associated with decreased risk of CV events, even in the secondary prevention setting. The introduction of endothelial function assessment into clinical practice may trigger the development of a more tailored and personalized medicine and improve patient outcomes. In this review, we summarize current knowledge on the contribution of endothelial dysfunction to atherosclerotic CV disease in the secondary prevention setting. Finally, we focus on the potential of an endothelial function-guided management strategy in secondary prevention.

Altered coronary endothelial function in young smokers detected by magnetic resonance assessment of myocardial blood flow during the cold pressor test

Endothelial dysfunction is a key element in early atherogenesis. The purposes of this study were to evaluate the feasibility of magnetic resonance (MR) assessment of altered myocardial blood flow (MBF) in response to the cold pressor test (CPT) and to determine if coronary endothelial dysfunction in young smokers can be detected with this noninvasive approach. Fourteen healthy non-smokers (31 ± 6 years) and 12 smokers (34 ± 8 years) were studied. Breath-hold phase-contrast cine MR imaging (PC-MRI) of the coronary sinus (CS) were obtained at rest and during the CPT. MBF was measured as CS flow divided by left ventricle mass and the rate pressure product. In non-smokers, MBF was 0.88 ± 0.19 ml/min/g at rest and significantly increased to 1.13 ± 0.26 ml/min/g during the CPT (P = 0.0001). In smokers, MBF was 0.94 ± 0.26 ml/min/g at rest and 0.96 ± 0.30 ml/min/g during the CPT (P = 0.73). ΔMBF (MBF during the CPT-MBF at rest) was significantly reduced in smokers compared with non-smokers (0.02 ± 0.20 vs. 0.26 ± 0.18 ml/min/g, P = 0.005). The intra-class correlation coefficient between measurements by two observers was 0.90 for ΔMBF. A significant reduction in MBF response to CPT was demonstrated in young smokers with PC-MRI at 1.5 T. This noninvasive method has great potential for assessment of coronary endothelial function.