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Rinaldi R, Colucci M, Torre I, Ausiello D, Bonanni A, Basile M, Salzillo C, Sanna T, Liuzzo G, Leone AM, Burzotta F, Trani C, Lanza GA, Niccoli G, Crea F, Montone RA. Predicting the response to acetylcholine in ischemia or infarction with non-obstructive coronary arteries: The ABCD score. Atherosclerosis 2024; 391:117503. [PMID: 38447435 DOI: 10.1016/j.atherosclerosis.2024.117503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/19/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIMS Acetylcholine (ACh) provocation testing can detect vasomotor disorders in patients with ischemia and non-obstructed coronary arteries (INOCA) or myocardial infarction and non-obstructed coronary arteries (MINOCA). We aimed to derive and validate a simple risk score to predict a positive ACh test response. METHODS We prospectively enrolled consecutive INOCA and MINOCA patients undergoing ACh provocation testing. Patients were split in two cohorts (derivation and validation) according to time of enrolment. The score was derived in 386 patients (derivation cohort) and then validated in 165 patients (validation cohort). RESULTS 551 patients were enrolled, 371 (67.3%) INOCA and 180 (32.7%) MINOCA. ACh test was positive in 288 (52.3%) patients. MINOCA, myocardial bridge (MB), C-reactive protein (CRP) and dyslipidaemia were independent predictors of a positive ACh test in the derivation cohort. The ABCD (Acute presentation, Bridge, CRP, Dyslipidaemia) score was derived: 2 points were assigned to MINOCA, 3 to MB, 1 to elevated CRP and 1 to dyslipidaemia. The ABCD score accurately identified patients with a positive ACh test response with an AUC of 0.703 (CI 95% 0.652-0.754,p < 0.001) in the derivation cohort, and 0.705 (CI 95% 0.626-0.784, p < 0.001) in the validation cohort. In the whole population, an ABCD score ≥4 portended 94.3% risk of a positive ACh test and all patients with an ABCD score ≥6 presented a positive test. CONCLUSIONS The ABCD score could avoid the need of ACh provocation testing in patients with a high score, reducing procedural risks, time, and costs, and allowing the implementation of a tailored treatment strategy. These results are hypothesis generating and further research involving larger cohorts and multicentre trials is needed to validate and refine the ABCD score.
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Affiliation(s)
- Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Colucci
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Ilaria Torre
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Davide Ausiello
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Alice Bonanni
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mattia Basile
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carmine Salzillo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Liuzzo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio M Leone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano A Lanza
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Sheth MA, Widmer RJ, Dandapantula HK. Pathobiology and evolving therapies of coronary artery vasospasm. Proc (Bayl Univ Med Cent) 2021; 34:352-360. [PMID: 33953459 DOI: 10.1080/08998280.2021.1898907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Coronary artery vasospasm is a known cause of chest pain and requires a high level of clinical suspicion for diagnosis. It also remains in the differential diagnosis for patients presenting with type 2 myocardial infarction. There are few randomized controlled trials for guideline-based prevention and treatment for coronary artery vasospasm. In this article, we review updated concepts in coronary artery vasospasm. Specifically, our aim is to provide current evidence of pathophysiology, identify the risk factors, propose a diagnostic algorithm, review available evidence of evolving therapies, and identify patients who would benefit from automatic implantable cardioverter defibrillators.
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Affiliation(s)
- Monish A Sheth
- Division of Hospital Medicine, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - Robert J Widmer
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas
| | - Hari K Dandapantula
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Medical Center, Temple, Texas
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Hwang YC, Hayashi T, Fujimoto WY, Kahn SE, Leonetti DL, McNeely MJ, Boyko EJ. Differential Association Between HDL Subclasses and the Development of Type 2 Diabetes in a Prospective Study of Japanese Americans. Diabetes Care 2015; 38:2100-5. [PMID: 26384391 PMCID: PMC4613920 DOI: 10.2337/dc15-0625] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 09/01/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent studies have suggested that HDL cholesterol is inversely associated with the development of type 2 diabetes. However, little is known about the association between different HDL subclasses and the risk for future type 2 diabetes. RESEARCH DESIGN AND METHODS The study enrolled 406 Japanese Americans (51% male) without diabetes, aged 34-75 years. Oral glucose tolerance tests were performed to determine type 2 diabetes status at baseline, 2.5 years, 5 years, and 10 years after enrollment. HDL2, HDL3, total HDL cholesterol, and visceral adipose tissue (VAT) area by computed tomography were measured at baseline. RESULTS In univariate analysis, total HDL and HDL2 cholesterol were inversely associated with the incidence of type 2 diabetes, but HDL3 cholesterol was not. In multivariate analysis, total HDL cholesterol (odds ratio per 1-SD increment, 0.72 [95% CI 0.52-0.995], P = 0.047) and HDL2 cholesterol (odds ratio per 1-SD increment, 0.64 [95% CI 0.44-0.93], P = 0.018) were inversely associated with the risk for type 2 diabetes independent of age, sex, BMI, waist circumference, family history of diabetes, lifestyle factors, systolic blood pressure, lipid-lowering medication use, triglyceride level, HOMA-insulin resistance, and 2-h glucose; however, HDL3 cholesterol was not associated with diabetes risk. The association between diabetes risk and total HDL and HDL2 cholesterol became insignificant after adjustment for VAT area. CONCLUSIONS Subjects with higher HDL2 cholesterol were at lower risk for incident type 2 diabetes, but this association was confounded by and not independent of VAT. Higher HDL3 cholesterol was not associated with diabetes risk.
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Affiliation(s)
- You-Cheol Hwang
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Tomoshige Hayashi
- Department of Preventive Medicine and Environmental Health, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Wilfred Y Fujimoto
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Steven E Kahn
- Department of Medicine, University of Washington School of Medicine, Seattle, WA Hospital and Specialty Medicine Service, VA Puget Sound Health Care System, Seattle, WA
| | - Donna L Leonetti
- Department of Anthropology, University of Washington, Seattle, WA
| | - Marguerite J McNeely
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA Department of Medicine, University of Washington School of Medicine, Seattle, WA
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Li XL, Li JJ, Guo YL, Zhu CG, Qing P, Wu NQ, Xu B, Gao RL. The ratio of high-density lipoprotein cholesterol to apolipoprotein A-I predicts myocardial injury following elective percutaneous coronary intervention. Clin Cardiol 2014; 37:558-65. [PMID: 25113039 DOI: 10.1002/clc.22308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/21/2014] [Accepted: 05/27/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND High-density lipoprotein (HDL) has cardioprotective properties. Each HDL particle has a few molecules of apolipoprotein A-I (apoA-I) and carries various amounts of cholesterol. The ratio of high-density lipoprotein cholesterol (HDL-C) to apoA-I may reflect mean HDL particle size. HYPOTHESIS HDL-C/apoA-I ratio may provide more information than HDL-C and apoA-I in predicting myocardial injury following elective percutaneous coronary intervention (PCI). METHODS We prospectively enrolled 2529 consecutive patients who underwent elective PCI and assessed the relationships of preprocedural HDL-C, apoA-I, and their ratio with peak cardiac troponin I (cTnI) within 24 hours after PCI. RESULTS Neither HDL-C nor apoA-I levels showed significant association with postprocedural cTnI elevation, whereas HDL-C/apoA-I ratio was associated with postprocedural cTnI elevation above 3 up to 30 × upper limit of normal (ULN), with the lowest risk in the middle quintile (all P values for quadratic term were <0.05). Adjusted odds ratios (95% confidence interval) of postprocedural cTnI >3 × ULN for quintile 1 to 5 of HDL-C/apoA-I ratio were: 1 (reference), 0.81 (0.62-1.07), 0.57 (0.43-0.75), 0.65 (0.49-0.85), and 0.76 (0.58-1.01), respectively, and the adjusted odds ratios of postprocedural cTnI >30 × ULN for quintile 1 to 5 of HDL-C/apoA-I ratio were: 1 (reference), 0.81 (0.49-1.361), 0.42 (0.23-0.77), 0.66 (0.38-1.14), and 0.82 (0.49-1.38), respectively. CONCLUSIONS There was a U-shaped association between HDL-C/apoA-I ratio and myocardial injury following PCI.
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Affiliation(s)
- Xiao-Lin Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hwang YC, Ahn HY, Park SW, Park CY. Association of HDL-C and apolipoprotein A-I with the risk of type 2 diabetes in subjects with impaired fasting glucose. Eur J Endocrinol 2014; 171:137-42. [PMID: 24760540 DOI: 10.1530/eje-14-0195] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES HDLs have many diverse functions. The goal of this study was to determine the association of HDL cholesterol (HDL-C) and apolipoprotein A-I (apoA-I) with the development of type 2 diabetes (T2D). In particular, this study determined the association between the ratio of HDL-C to apoA-I (HA) and incident T2D. DESIGN AND METHODS A total of 27 988 subjects with impaired fasting glucose (IFG) (18 266 men and 9722 women) aged 21-91 years (mean age 40.7 years) were followed for a mean duration of 2.81 years. RESULTS Study subjects were divided into quartiles according to the baseline HA ratio. Age, male sex, current smoking, BMI, waist circumference, and high-sensitivity C-reactive protein decreased across the quartiles, and all metabolic profiles, including blood pressure, fasting glucose, insulin resistance as determined by homeostasis model assessment of insulin resistance, and lipid measurements such as total cholesterol, LDL cholesterol, non-HDL-C, and apoB, improved as the HA ratio increased. In addition, incident cases of T2D decreased as the HA ratio increased, independent of age, sex, BMI, current smoking, systolic blood pressure, HbA1c, fasting serum insulin, family history of diabetes, and serum triglyceride concentrations (HR (95% CI) of fourth quartile vs first quartile; 0.76 (0.67-0.86), P<0.0001). CONCLUSIONS A higher HA ratio was associated with favorable metabolic profiles and a lower risk of T2D development in subjects with IFG.
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Affiliation(s)
- You-Cheol Hwang
- Division of Endocrinology and MetabolismDepartment of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of KoreaDepartment of StatisticsDongguk University-Seoul, Seoul, Republic of KoreaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Pyung-Dong, Jongro-Gu, 110-746 Seoul, Republic of Korea
| | - Hong-Yup Ahn
- Division of Endocrinology and MetabolismDepartment of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of KoreaDepartment of StatisticsDongguk University-Seoul, Seoul, Republic of KoreaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Pyung-Dong, Jongro-Gu, 110-746 Seoul, Republic of Korea
| | - Sung-Woo Park
- Division of Endocrinology and MetabolismDepartment of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of KoreaDepartment of StatisticsDongguk University-Seoul, Seoul, Republic of KoreaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Pyung-Dong, Jongro-Gu, 110-746 Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and MetabolismDepartment of Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of KoreaDepartment of StatisticsDongguk University-Seoul, Seoul, Republic of KoreaDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Pyung-Dong, Jongro-Gu, 110-746 Seoul, Republic of Korea
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Impact of high-density lipoprotein cholesterol level in patients with variant angina pectoris. Int J Cardiol 2010; 140:175-81. [DOI: 10.1016/j.ijcard.2008.11.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 09/23/2008] [Accepted: 11/08/2008] [Indexed: 11/21/2022]
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Miwa K, Makita T, Ishii K, Okuda N, Taniguchi A. High remnant lipoprotein levels in patients with variant angina. Clin Cardiol 2004; 27:338-42. [PMID: 15237693 PMCID: PMC6653988 DOI: 10.1002/clc.4960270608] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Dyslipidemia with increased oxidative stress but without elevation of low-density lipoprotein cholesterol has been recently implicated in the pathogenesis of coronary vasospasm. HYPOTHESIS Disordered triglyceride-rich lipoprotein metabolism may be linked to the genesis of coronary artery spasm. METHODS Both serum remnant lipoprotein (RLP) and alpha-tocopherol levels were determined in 18 patients with the active stage of variant angina (VA), in 16 patients with the inactive stage of variant angina (IVA), and in 19 control subjects (CONTROL). RESULTS The RLP levels were significantly (p < 0.05) higher in VA (6.4 +/- 2.7 mg/dl) than in IVA (4.4 +/- 1.5 mg/dl). In contrast, alpha-tocopherol levels were significantly lower in VA than that in CONTROL. Serum trigyceride levels were not significantly different among the study groups, although serum high-density lipoprotein cholesterol levels were significantly lower in VA than in CONTROL. Smoking was significantly (p < 0.05) more prevalent in VA (72%) than in IVA (25%) and CONTROL (37%). Serum RLP levels correlated positively with triglyceride levels (R = 0.73) and correlated inversely with alpha-tocopherol levels (R = -0.31) significantly in all study subjects. CONCLUSIONS Patients with active stage of variant angina had higher RLP levels than inactive patients with variant angina and lower alpha-tocopherol levels than control subjects. Disordered triglyceride-rich lipoprotein metabolism with increased oxidative stress appears to be linked to the activity of coronary vasospasm, suggesting a possible role in its pathogenesis.
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Affiliation(s)
- Kunihisa Miwa
- Second Department of Internal Medicine, Kansai Electric Power Hospital, Osaka, Japan.
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Abstract
Increased lipid oxidative stress has been recently implicated in the pathogenesis of coronary artery spasm. Small, dense LDL with high susceptibility to oxidation may be linked to the genesis of coronary vasospasm. The relative migratory distance of the predominant densitometric peak of LDL from that of VLDL to that of HDL in a 3% polyacrylamide gel electrophoresis was determined as a measure of LDL particle size in 49 patients with coronary spastic angina (CSA), in 56 patients with stable effort angina and a significant coronary artery stenosis (SEA) and also in 40 control subjects without coronary artery disease (Control). The incidence of detection of small, dense LDL (particle diameter <25.5 nm) or a relative migratory distance above 0.36 was significantly higher in CSA (57%) and also in SEA (39%) than in Control (20%). In SEA, a significantly higher serum level of triglyceride was noted in the subgroup with the small, dense LDL as compared with the subgroup without. In contrast, in CSA, the serum level of triglyceride was not significantly different between the subgroups with and without the small, dense LDL, although significantly lower serum levels of both HDL-cholesterol and alpha-tocopherol were noted in the former. In 16 patients of CSA, the detection of the small, dense LDL was significantly decreased after a >6-month angina-free period (69-->31%). We conclude that patients with coronary spastic angina had smaller LDL particles, associated not with hypertriglyceridemia but low serum levels of both HDL-cholesterol and vitamin E. Dyslipidemia with small, dense LDL may be related to the genesis of coronary vasospasm.
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Affiliation(s)
- Kunihisa Miwa
- The Second Department of Internal Medicine, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, 553-0003, Osaka, Japan
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Wang CH, Kuo LT, Hung MJ, Cherng WJ. Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. Am Heart J 2002; 144:275-81. [PMID: 12177645 DOI: 10.1067/mhj.2002.123843] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Abnormal levels of serum cardiac troponin I (cTnI) are occasionally found in patients presenting with acute coronary syndromes but having insignificant coronary artery disease. Before one concludes that an abnormal cTnI level is a false-positive result, the possibility of coronary vasospasm should be considered. This study investigated whether coronary vasospasm could be a reason for elevated cTnI in this patient population. METHODS AND RESULTS This investigation enrolled 93 patients who presented to the emergency department with suspected coronary ischemia and had insignificant coronary artery disease. cTnI was elevated in 23 patients (25%) and was normal in 70 patients (75%). Coronary vasospasm, documented by an ergonovine provocation test, was found in 38 patients (41%). Patients with elevated cTnI levels, compared with those with normal cTnI, were older (63 +/- 13 y vs 56 +/- 14 y, P =.032), had a higher incidence of males (78% vs 52%, P =.049) and positive ergonovine provocation tests (74% vs 30%, P <.0001), and tended to have a lower incidence of hypercholesterolemia (26% vs 48%, P =.088) and normal electrocardiograms (48% vs 70%, P =.078). Multivariate analysis showed that the variables independently associated with an elevated cTnI level included coronary vasospasm (odds ratio 2.41, 95% CI 1.48-3.18, P <.0001) and hypercholesterolemia (odds ratio 0.64, 95% CI 0.47-0.99, P =.049). Coronary vasospasm (positive ergonovine provocation test) could explain 74% of elevated cTnI levels in patients with insignificant coronary stenosis. CONCLUSIONS In patients with acute coronary syndrome with elevated cTnI and insignificant coronary artery disease, the possibility of coronary vasospasm as a cause of elevated cTnI should be considered.
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Affiliation(s)
- Chao-Hung Wang
- Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
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Miwa K, Nakagawa K, Suzuki K, Inoue H. Detection of the "midband" lipoprotein in patients with coronary artery spasm. Clin Cardiol 2001; 24:219-24. [PMID: 11288968 PMCID: PMC6655076 DOI: 10.1002/clc.4960240309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2000] [Accepted: 06/20/2000] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Dyslipidemia in patients with coronary vasospasm has been characterized by a low level of high-density lipoprotein (HDL) cholesterol without elevation of low-density lipoprotein (LDL) cholesterol, distinct from patients with organic coronary artery disease. HYPOTHESIS Disordered triglyceride-rich lipoprotein metabolism may be linked to the genesis of coronary artery spasm. METHODS The incidence of the "midband" lipoprotein observed between very low-density lipoprotein (VLDL) and LDL bands in the polyacrylamide disc gel electrophoretic analysis was determined in 48 patients with coronary spastic angina (CSA), in 50 patients with stable effort angina and a significant fixed coronary stenosis (SEA), and in 40 control subjects without coronary artery disease (Control). RESULTS The incidence was significantly (p<0.05) higher in CSA (71%) than in SEA (50%) and Control (25%). Smoking was significantly (p < 0.05) more prevalent in CSA (77%) than in SEA (50%) and Control (50%). In SEA, serum levels of triglyceride and apoproteins C-II, C-III, and E were all significantly higher, and the serum level of HDL cholesterol was significantly lower in the midband-positive than in the midband-negative subgroup. In CSA, no significant differences were found in these serum levels between the midband-positive and -negative subgroups, except for a significantly (p < 0.05) lower level of HDL cholesterol in the former. However, a significantly (p < 0.05) higher incidence of diabetes mellitus or impaired glucose tolerance was noted in the midband-positive (41%) than in the midband-negative subgroup (7%) in CSA. The incidence of the detected midband lipoprotein was significantly decreased in the blood samples obtained from 20 of CSA after a > 6-month angina-free period (70-->25%, p < 0.05). CONCLUSIONS The midband lipoprotein was frequently detected in patients with coronary vasospasm, suggesting that dyslipidemia with disordered triglyceride-rich lipoprotein metabolism may be linked to the genesis of coronary artery spasm.
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Affiliation(s)
- K Miwa
- The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan
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Cerne D, Ledinski G, Kager G, Greilberger J, Wang X, Jürgens G. Comparison of laboratory parameters as risk factors for the presence and the extent of coronary or carotid atherosclerosis: the significance of apolipoprotein B to apolipoprotein all ratio. Clin Chem Lab Med 2000; 38:529-38. [PMID: 10987202 DOI: 10.1515/cclm.2000.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We compared several "new" risk factors (autoantibodies to oxidatively modified low density lipoprotein (LDL), sialic acid content of LDL, bilirubin and C-reactive protein) with "conventional" risk factors (apolipoprotein (apo) AI, AII and B, lipoprotein(a), triglycerides, and total, LDL and high density lipoprotein (HDL) cholesterol) for the presence and the extent of coronary or carotid atherosclerosis. Forty male patients with angiographically proven coronary atherosclerosis and 31 male patients with ultrasound-proven extracranial carotid atherosclerosis were compared to 40 age matched (53+/-5 years) healthy males as control subjects, with negative parental history of atherosclerosis, no clinical signs of systemic or organ-related ischemic disease and normal extracranial carotid arteries. The apo B/apo All ratio most powerfully indicated the presence and the extent of coronary or carotid atherosclerosis. Elevated lipoprotein(a) contributed significant additional information in the assessment of the atherosclerotic risk. Increase in C-reactive protein indicated the presence (but not the extent) of coronary or carotid atherosclerosis with a similar power as lipoprotein(a). Decreased values of total bilirubin indicated the presence of atherosclerosis only in smokers. Autoantibodies to oxidatively modified LDL additionally described the atherosclerotic process, but were less important than apolipoproteins, lipoprotein(a), C-reactive protein or bilirubin. Sialic acid content of LDL added no information to the parameters discussed above. We demonstrated that in male patients apolipoproteins, especially the apo B/apo All ratio, were better indicators of the presence and the extent of coronary or carotid atherosclerosis than C-reactive protein, bilirubin, autoantibodies to oxidatively modified LDL or sialic acid content of LDL.
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Affiliation(s)
- D Cerne
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre of Ljubljana, Slovenia
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Miwa K, Nakagawa K, Yoshida N, Taguchi Y, Inoue H. Lipoprotein(a) is a risk factor for occurrence of acute myocardial infarction in patients with coronary vasospasm. J Am Coll Cardiol 2000; 35:1200-5. [PMID: 10758961 DOI: 10.1016/s0735-1097(00)00550-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study is to determine whether lipoprotein(a) (Lp[a]) is an independent risk factor for coronary spasm and occurrence of acute myocardial infarction (AMI) in patients with coronary spasm. BACKGROUND Although elevated serum Lp(a) levels are known to be associated with coronary atherosclerosis and AMI, the association between the elevated level of this lipoprotein and coronary spasm remains to be elucidated. METHODS Serum Lp(a) levels were measured using a latex immunoassay in 77 patients with coronary spasm but without a significant (>75%) fixed coronary stenosis, including 16 with prior myocardial infarction (MI), in 177 patients with a fixed stenosis but without rest angina, including 114 with prior MI and in 81 control subjects without coronary artery disease. RESULTS The serum Lp(a) level in patients with coronary spasm (median; 17 mg/dl) was higher (p < 0.01) than in control subjects (12 mg/dl) but lower (p < 0.01) than in patients with a fixed stenosis (23 mg/dl). The incidence of subjects with higher (>25 mg/dl) serum Lp(a) levels was higher in patients with a fixed stenosis (46%, p < 0.01) but not in patients with coronary spasm (27%), compared with control subjects (21%). Among the patients with coronary spasm, the incidence of higher Lp(a) levels was higher in patients with than in those without a history of prior MI (56% vs. 21%, p < 0.05). The patients with higher Lp(a) levels had a higher incidence of prior MI than those without (41% vs. 13%, p < 0.05). The multivariate analysis confirmed that higher serum Lp(a) level is an independent determinant for prior MI in these patients (odds ratio, 4.19; 95%, confidence interval, 1.03 to 17.00). CONCLUSIONS Elevated serum level of Lp(a) was found to be associated with a history of prior MI in patients with coronary spasm, suggesting that Lp(a) may play an important role in the genesis of thrombotic coronary occlusion and the occurrence of AMI subsequent to coronary spasm.
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Affiliation(s)
- K Miwa
- The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Japan.
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