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Tanazawa K, Akioka H, Yufu K, Makita T, Sato H, Iwabuchi Y, Ono Y, Yamasaki H, Takahashi M, Ogawa N, Harada T, Mitarai K, Kodama N, Yamauchi S, Takano M, Hirota K, Miyoshi M, Yonezu K, Tawara K, Abe I, Kondo H, Saito S, Fukui A, Fukuda T, Shinohara T, Akiyoshi K, Teshima Y, Takahashi N. Association between serum level of uric acid in Japanese young patients with coronary spastic angina receiving coronary angiography. Heart Vessels 2024:10.1007/s00380-024-02469-4. [PMID: 39368018 DOI: 10.1007/s00380-024-02469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 09/25/2024] [Indexed: 10/07/2024]
Abstract
Endothelial dysfunction may trigger coronary spastic angina (CSA). However, the risk factors for CSA in young patients remain unclear. This study aimed to investigate the age-dependent role of serum uric acid levels in patients with CSA. We enrolled 423 patients who underwent an ergonovine tolerance test during coronary angiography for the CSA evaluation. We categorized the patients as (1) young (age ≤ 65 years) CSA-positive (n = 33), (2) young CSA-negative (n = 138), (3) elderly (age > 66 years) CSA-positive (n = 42), and (4) elderly CSA-negative (n = 210) groups. In the young groups, the smoker proportion (57.6 vs. 38.4%, p = 0.04) and serum uric acid levels (6.3 ± 1.4 vs. 5.4 ± 1.5 mg/dl, p = 0.006) were significantly higher in the CSA-positive compared with the CSA-negative group. Conversely, in the elderly group, the male proportion (66.6 vs. 47.1%, p = 0.02) and alcohol consumption level (40.5 vs. 21.0%, p = 0.01) were significantly higher in the CSA-positive compared with the CSA-negative group. The multivariate analysis in young groups revealed the independent association between the serum uric acid level (p = 0.02) and the presence of CSA. Our results indicate that elevated serum uric acid levels may affect CSA development in young patients.
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Affiliation(s)
- Kota Tanazawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Taiki Makita
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Yuki Iwabuchi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Yuma Ono
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hirochika Yamasaki
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Masaki Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Naoko Ogawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Taisuke Harada
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kazuki Mitarai
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Nozomi Kodama
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Shuichiro Yamauchi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Masayuki Takano
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Miho Miyoshi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Katsunori Tawara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Ichitaro Abe
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Shotaro Saito
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tomoko Fukuda
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kumiko Akiyoshi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
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Teragawa H, Uchimura Y, Oshita C, Hashimoto Y, Nomura S. Clinical Characteristics and Major Adverse Cardiovascular Events in Diabetic and Non-Diabetic Patients with Vasospastic Angina. Diabetes Metab Syndr Obes 2024; 17:2135-2146. [PMID: 38812745 PMCID: PMC11135563 DOI: 10.2147/dmso.s462234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose The clinical background and prognostic impact of diabetes mellitus (DM) on vasospastic angina (VSA) are unclear; thus, in this retrospective study, we investigated whether they differ based on the presence or absence of DM in patients with VSA. Patients and Methods We included 272 Japanese patients with VSA diagnosed by coronary angiography (CAG) and the spasm provocation test (SPT). The diagnosis of DM was determined by measuring fasting blood glucose and hemoglobin A1C and by the patient's current oral medications. On CAG, the presence of atherosclerotic lesions (20%-50%) was checked. On SPT, the coronary spasm was defined as transient coronary vasoconstriction >90% on CAG, accompanied by chest symptoms and/or ST-T changes. Focal spasm was defined as coronary spasm occurring within one segment of the American Heart Association classification on CAG. Blood and urine tests and vascular endothelial function were also evaluated when possible. A major adverse cardiovascular event (MACE), which is defined as cardiac mortality and rehospitalization due to cardiovascular illness, was the basis for determining the prognosis. Results There were 49 patients (18%) in the DM group and 223 (82%) in the non-DM group. No significant differences in urinary albumin levels and peripheral vascular function were between groups. On CAG, atherosclerotic lesions were observed significantly more frequently in the DM group (63% vs 46%; P = 0.028). Results of SPT showed a trend toward fewer focal spasms in the DM group (24% vs 39%; P = 0.072). No significant differences in MACE were noted between groups in the primary analysis of DM, whereas sub-analyses of focal spasms showed lower MACE-free survival in the DM group (P = 0.042). Conclusion The study results support the hypothesis that DM associated with VSA should be treated appropriately, especially in cases of focal spasm, which may require more attention in treatment.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Yuko Uchimura
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Yu Hashimoto
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
| | - Shuichi Nomura
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan
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Rha SW, Lee K, Choi SY, Byun JK, Cha J, Hyun S, Ahn WJ, Park S, Kang DO, Park EJ, Choi CU, Choi BG. Long-term prognostic factors for cardiovascular events in patients with chest pain without diabetes mellitus nor significant coronary stenosis. Heart Vessels 2024; 39:382-391. [PMID: 38324195 DOI: 10.1007/s00380-023-02348-4] [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: 07/24/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024]
Abstract
Chest pain is the most common symptom of coronary artery disease (CAD) and diabetes mellitus (DM) is a well-known single strongest risk factor for cardiovascular diseases. Thus, the impact of CAD nor DM on long-term clinical effects is reported widely, but the prognostic factors of non-DM patients presenting with chest pain without significant CAD are limited. A total of 1,046 patients with chest pain without DM and significant CAD who underwent coronary angiography (CAG) and acetylcholine (ACH) provocation tests were finally enrolled. Propensity score matching and multivariate Cox-proportional hazard ratio analysis were performed to adjust for baseline potential confounders. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of total death, myocardial infarction (MI), revascularization, stroke, and recurrent angina. This study aimed to evaluate the long-term prognostic factors for MACCE in patients with chest pain without DM and CAD up to 5 years. Coronary artery spasm (CAS) was the most common cause of chest pain. However, long-term MACCE of CAS was not worse than those of patients with chest pain without CAS when patients with CAS had subsequent optimal antianginal medication therapy. However, a recurrent chest pain remains a problem even with continuous antianginal medication therapy. Up to 5 years, the incidence of MACCE was in 7.3%, including recurrent angina 6.9%. Dyslipidemia (HR: 2.010, 95% CI 1.166-3.466, P = 0.012), mild-moderate (30-70%) coronary stenosis (HR: 2.369, 95% CI 1.118-5.018, P = 0.024), the use of aspirin (HR: 2.885, 95% CI 1.588-5.238, P < 0.001), and the use of nitrates (HR: 1.938, 95% CI 1.094-3.433, P = 0.023) were independent risk factors for MACCE. Among the patients with chest pain without DM and significant CAD, the incidence of MACE were rare, but recurrent angina was still a challenging problem who had treated with antianginal medications.
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Affiliation(s)
- Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea.
| | - Kyuho Lee
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Suwon, Korea
- Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Seoul, Korea
| | - Se Yeon Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jae Kyeong Byun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Jinah Cha
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Sujin Hyun
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Woo Jin Ahn
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Soohyung Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Dong Oh Kang
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Eun Jin Park
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Cheol Ung Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea.
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Nivoit P, Mathivet T, Wu J, Salemkour Y, Sankar DS, Baudrie V, Bourreau J, Guihot AL, Vessieres E, Lemitre M, Bocca C, Teillon J, Le Gall M, Chipont A, Robidel E, Dhaun N, Camerer E, Reynier P, Roux E, Couffinhal T, Hadoke PWF, Silvestre JS, Guillonneau X, Bonnin P, Henrion D, Dengjel J, Tharaux PL, Lenoir O. Autophagy protein 5 controls flow-dependent endothelial functions. Cell Mol Life Sci 2023; 80:210. [PMID: 37460898 PMCID: PMC10352428 DOI: 10.1007/s00018-023-04859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
Dysregulated autophagy is associated with cardiovascular and metabolic diseases, where impaired flow-mediated endothelial cell responses promote cardiovascular risk. The mechanism by which the autophagy machinery regulates endothelial functions is complex. We applied multi-omics approaches and in vitro and in vivo functional assays to decipher the diverse roles of autophagy in endothelial cells. We demonstrate that autophagy regulates VEGF-dependent VEGFR signaling and VEGFR-mediated and flow-mediated eNOS activation. Endothelial ATG5 deficiency in vivo results in selective loss of flow-induced vasodilation in mesenteric arteries and kidneys and increased cerebral and renal vascular resistance in vivo. We found a crucial pathophysiological role for autophagy in endothelial cells in flow-mediated outward arterial remodeling, prevention of neointima formation following wire injury, and recovery after myocardial infarction. Together, these findings unravel a fundamental role of autophagy in endothelial function, linking cell proteostasis to mechanosensing.
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Affiliation(s)
- Pierre Nivoit
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | - Thomas Mathivet
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | - Junxi Wu
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, G4 ONW, UK
| | - Yann Salemkour
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | | | - Véronique Baudrie
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | - Jennifer Bourreau
- MITOVASC, CNRS UMR 6015, Inserm U1083, Université d'Angers, 49500, Angers, France
| | - Anne-Laure Guihot
- MITOVASC, CNRS UMR 6015, Inserm U1083, Université d'Angers, 49500, Angers, France
| | - Emilie Vessieres
- MITOVASC, CNRS UMR 6015, Inserm U1083, Université d'Angers, 49500, Angers, France
| | - Mathilde Lemitre
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | - Cinzia Bocca
- MITOVASC, CNRS UMR 6015, Inserm U1083, Université d'Angers, 49500, Angers, France
- Département de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire d'Angers, 49500, Angers, France
| | - Jérémie Teillon
- CNRS, Inserm, Bordeaux Imaging Center, BIC, UMS 3420, US 4, Université de Bordeaux, 33000, Bordeaux, France
| | - Morgane Le Gall
- Plateforme Protéomique 3P5-Proteom'IC, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, 75014, Paris, France
| | - Anna Chipont
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | - Estelle Robidel
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | - Neeraj Dhaun
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Eric Camerer
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France
| | - Pascal Reynier
- MITOVASC, CNRS UMR 6015, Inserm U1083, Université d'Angers, 49500, Angers, France
- Département de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire d'Angers, 49500, Angers, France
| | - Etienne Roux
- Inserm, Biologie Des Maladies Cardiovasculaires, U1034, Université de Bordeaux, 33600, Pessac, France
| | - Thierry Couffinhal
- Inserm, Biologie Des Maladies Cardiovasculaires, U1034, Université de Bordeaux, 33600, Pessac, France
| | - Patrick W F Hadoke
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | | | - Xavier Guillonneau
- Institut de La Vision, INSERM, CNRS, Sorbonne Université, 75012, Paris, France
| | - Philippe Bonnin
- AP-HP, Hôpital Lariboisière, Physiologie Clinique - Explorations Fonctionnelles, Hypertension Unit, Université Paris Cité, 75010, Paris, France
| | - Daniel Henrion
- MITOVASC, CNRS UMR 6015, Inserm U1083, Université d'Angers, 49500, Angers, France
| | - Joern Dengjel
- Department of Biology, University of Fribourg, 1700, Fribourg, Switzerland
| | | | - Olivia Lenoir
- Inserm, Université Paris Cité, PARCC, 56 Rue Leblanc, 75015, Paris, France.
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Zhang J, Liu L, Liu C, Han M, Xu C, Qiu R. Diltiazem is a useful and effective medication for reversal of coronary artery spasm-induced complete atrioventricular block: A case report. Front Cardiovasc Med 2023; 10:1134658. [PMID: 37077742 PMCID: PMC10106591 DOI: 10.3389/fcvm.2023.1134658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Coronary artery spasm (CAS) is characterized by reversible diffuse or focal vasoconstriction, a phenomenon that plays an important role in the pathogenesis of ischemic heart disease. Fatal arrhythmias, such as ventricular tachycardia/fibrillation and complete atrioventricular block (AV-B), are very common in patients with CAS. Nondihydropyridine calcium channel blockers (CCBs) such as diltiazem were recommended as first-line medications for treating and preventing CAS episodes. However, its use remains controversial in CAS patients with AV-B as this type of CCB can also cause AV-B itself. Here, we present the use of diltiazem in a patient with complete AV-B caused by CAS. The patient's chest pain was rapidly relieved, and complete AV-B was promptly restored to sinus rhythm following the administration of intravenous diltiazem without any adverse effects. In this report, we highlight the useful and effective application of diltiazem for treating and preventing complete AV-B caused by CAS.
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Affiliation(s)
- Jin Zhang
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
- Department of Cardiology, Medical College of Wuhan University of Science and Technology, Wuhan, China
| | - Li Liu
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
- Correspondence: Li Liu Chengwei Liu
| | - Chengwei Liu
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
- Correspondence: Li Liu Chengwei Liu
| | - Min Han
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Chengyi Xu
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Rujie Qiu
- Division of Cardiac Care Unit, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
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6
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Hung MY, Hung MJ. Relationship between Inflammation and Vasospastic Angina. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020318. [PMID: 36837519 PMCID: PMC9960836 DOI: 10.3390/medicina59020318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple presentations, including sudden cardiac death. Despite investigations to explore its pathogenesis, no single mechanism has been found to explain the entire process of VSA occurrence. The roles of elevated local and systemic inflammation have been increasingly recognized in VSA. Treatment strategies to decrease local and systemic inflammation deserve further investigation.
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Affiliation(s)
- Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Ming-Jui Hung
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
- Correspondence:
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7
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Oda M, Fujibayashi K, Wakasa M, Takano S, Fujita W, Kitayama M, Nakanishi H, Saito K, Kawai Y, Kajinami K. Increased plasma glutamate in non-smokers with vasospastic angina pectoris is associated with plasma cystine and antioxidant capacity. SCAND CARDIOVASC J 2022; 56:180-186. [PMID: 35695518 DOI: 10.1080/14017431.2022.2085884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. Endothelial dysfunction caused by oxidative stress plays an important role in the development of vasospastic angina pectoris (VSAP). Glutamate causes endothelial dysfunction by generating oxidative stress, and it inhibits cystine import into endothelial cells via the cystine/glutamate antiporter (XC-), which leads to depletion of antioxidant glutathione. However, whether glutamate and cystine are implicated in the pathogenesis of VSAP remains unclear. We investigated plasma glutamate and cystine levels, oxidative stress markers and antioxidant capacity in non-smoker patients with VSAP to determine whether glutamate and cystine are associated with the development of VSAP. We assessed 49 non-smokers assigned to groups with (n = 27) and without (n = 22) VSAP, and also measured plasma glutamate, cystine, nitrotyrosine, reactive oxygen metabolites and biological antioxidant potential. Results. Plasma glutamate and cystine values were significantly higher in the group with, than without VSAP (59.8 ± 25.7 vs. 43.5 ± 18.7 µmol/L, p = .016 and 35.3 ± 14.2 vs. 25.2 ± 9.1 µmol/L, p = .0056, respectively). Plasma glutamate and cystine values were significantly and positively associated (r = 0.32, p = .027). Levels of the oxidative stress markers nitrotyrosine and reactive oxygen metabolites, and biological antioxidant potential of as a measure of antioxidant capacity, did not significantly differ between the two groups. However, glutamate and biological antioxidant potential values were significantly and negatively associated (r = -0.3, p = .036). Conclusion. Plasma glutamate levels were increased in patients with VSAP who did not smoke, and they were positively associated with plasma cystine and negatively associated with the biological antioxidant potential levels.
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Affiliation(s)
- Minako Oda
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | | | - Minoru Wakasa
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Shintaro Takano
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Wataru Fujita
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | | | - Hiroaki Nakanishi
- Department of Forensic Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuyuki Saito
- Department of Forensic Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, Ishikawa, Japan
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8
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Karimi Y, Sehati F, Sarreshtedari A, Mirzad M, Khalili Y, Kiani R, Taheri Bajgan E, Hosseini Moghadam M, Mehrvarz F, Bakhshandeh H, Parham M, Malakootian M, Sadeghipour P. Endothelial nitric oxide synthase Asp298Glu (894G/T) gene polymorphism as a possible risk factor for the coronary slow flow phenomenon among Iranians. BMC Cardiovasc Disord 2022; 22:300. [PMID: 35773625 PMCID: PMC9248196 DOI: 10.1186/s12872-022-02736-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Mounting evidence indicates an association between endothelial dysfunction and the coronary slow flow phenomenon (CSFP). In the present study, we aimed to evaluate the possible role of endothelial nitric oxide synthase (eNOS) 894G/T and interleukin-1β (IL-1β) 315C/T polymorphisms as possible risk factors for CSFP. Methods This prospective study enrolled patients with CSFP and individuals with normal coronary arteries. Genotypes were assessed using regular polymerase chain reaction and direct Sanger-sequencing techniques. Results The study population consisted of 267 individuals: 180 patients with CSFP (49 women [27.2%]) at a median age of 55 (48–62) years and 87 controls with normal coronary arteries (56 women [64.4%]) at a median age of 47 (41–58) years. The allelic distribution of eNOS 894G/T was significantly associated with CSFP (odds ratio [OR], 1.58; 95% confidence interval (CI), 1.04–2.42; P = 0.03). This polymorphism increased the risk of CSFP under the dominant model (OR 1.73; 95% CI I.02–2.95; P = 0.04). However, the allelic frequencies (1.05; 95% CI 0.68–1.59; P = 0.83) and genotypic frequencies (0.88; 95% CI 0.52–1.49; P = 0.63) of the IL-1β 315C/T polymorphism were not associated with the incidence of CSFP in the Iranian population. Conclusions The CSFP and control groups were statistically different regarding the eNOS 894G/T polymorphism. Our findings also demonstrated that the IL-1β 315C/T polymorphism was not a risk factor for CSFP. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02736-0.
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Affiliation(s)
- Yeganeh Karimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sehati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sarreshtedari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Mirzad
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yasaman Khalili
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Reza Kiani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Elham Taheri Bajgan
- Molecular Genetics Department, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Hosseini Moghadam
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Farzaneh Mehrvarz
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Parham
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran
| | - Mahshid Malakootian
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran.
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran. .,Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, Niyayesh Blvd, Tehran, 1996911101, Iran.
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9
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Park KH, Park WJ, Kim HS, Jo SH, Kim SA, Choi HM, Suh SW. Association between 10-Year Atherosclerotic Cardiovascular Disease Risk and Vascular Endothelial Function in Patients with Vasospastic Angina. Cardiology 2021; 146:281-287. [PMID: 33849014 DOI: 10.1159/000513141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endothelial dysfunction is a predictor of atherosclerotic cardiovascular disease (ASCVD) and plays an important role in vasospastic angina (VA). OBJECTIVES This study evaluated whether flow-mediated dilation (FMD) is also a good marker of 10-year ASCVD risk (10Y-ASCVDR) in patients with VA. METHODS Based on their clinical history and coronary artery diameter stenosis (DS), patients were retrospectively enrolled into VA (DS <50% and positive ergonovine provocation), minor coronary artery disease (mCAD, DS <30%), and significant coronary artery disease (sCAD, DS ≥50%) groups. Endothelial function was evaluated by FMD. RESULTS Each group contained 50 patients. The 10Y-ASCVDR was significantly higher in the sCAD group than in the VA and mCAD groups (10.86 ± 7.30, 4.71 ± 4.04, and 4.77 ± 4.30, respectively, p < 0.001). The FMD was significantly higher in the mCAD group than in the VA and sCAD groups (6.37 ± 4.25, 3.10 ± 2.23, and 3.07 ± 1.89, respectively, p < 0.001). A significant correlation was found between the FMD and 10Y-ASCVD in the mCAD group (r = -0.622, p < 0.001) and the sCAD group (r = -0.557, p < 0.001) but not in the VA group (r = -0.193, p = 0.179). After adjusting for potential confounders such as BMI, C-reactive protein, maximal coronary stenosis, and brachial-ankle pulse wave velocity, multivariate analysis showed that FMD was independently associated with 10Y-ASCVDR in all patients. However, when looking only at the VA group, FMD did not correlate independently with 10Y-ASCVDR. CONCLUSIONS Unlike mCAD and sCAD, we found no correlation between 10Y-ASCVDR and endothelial function in VA. Thus, our results support that FMD is not a good marker of atherosclerotic cardiovascular risk in VA.
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Affiliation(s)
- Kyoung-Ha Park
- Division of Cardiovacular Disease, Hallym University Medical Center, Anyang, Republic of Korea
| | - Woo Jung Park
- Division of Cardiovacular Disease, Hallym University Medical Center, Anyang, Republic of Korea
| | - Hyun-Sook Kim
- Division of Cardiovacular Disease, Hallym University Medical Center, Anyang, Republic of Korea
| | - Sang Ho Jo
- Division of Cardiovacular Disease, Hallym University Medical Center, Anyang, Republic of Korea
| | - Sung-Ai Kim
- Division of Cardiovacular Disease, Hallym University Medical Center, Anyang, Republic of Korea
| | - Hong-Mi Choi
- Division of Cardiovacular Disease, Hallym University Medical Center, Anyang, Republic of Korea
| | - Sang Won Suh
- Department of Physiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
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10
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Choi BG, Kim JB, Rha SW, Kim SW, Lee MW, Lee MS, Choi SY, Byun JK, Cha J, Na JO, Choi CU, Park CG, Seo HS, Oh DJ, Hong S. A relationship between unrecognized anaemia and the development of type 2 diabetes mellitus in patient with cardiovascular risks. Clin Exp Pharmacol Physiol 2021; 48:455-462. [PMID: 33340144 DOI: 10.1111/1440-1681.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
Studies on anaemia in diabetic patients are well known. However, the data regarding association of anaemia on the development of diabetes mellitus (DM) are very limited. We aimed to evaluate the association of anaemia on the development of DM and major clinical outcomes in a series of the Korean population during 5-year clinical follow-up. The patients were retrospectively enrolled using the electronic database of Korea University Guro Hospital from January 2004 to February 2013. A total of 17 515 subjects without a history of DM were analysed. The World Health Organization definition of anaemia was used. Patients were divided into the anaemia group (n = 2907 patients) and the non-anaemia group (n = 14 608 patients). The primary endpoint was the development of DM. To adjust baseline potential confounders, a propensity score matching (PSM) analysis was performed. After PSM analysis, two matched groups (2731 pairs) were generated and their baselines characteristics were balanced. During 5-year follow-up, the anaemia group had a higher incidence of type 2 DM (10.7% vs 7.7%; hazard ratio [HR], 1.356; 95% confidence interval [CI], 1.021-1.802; P = .035), and total death (2.6% vs 1.2%; HR, 2.449; 95% CI, 1.337-4.486; P = .004) compared to the non-anaemia group. In the present study, anaemia was associated with higher rate of the development of DM and mortality during 5-year clinical follow-up. A randomized trial is needed to determine whether this results can be reproducible or not for the final conclusion.
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Affiliation(s)
- Byoung Geol Choi
- Cardiovascular Intervention Research Institute, Seoul, Korea
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jung Boone Kim
- Department of Integrated Biomedical and Life Sciences, Korea University Graduate School, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Intervention Research Institute, Seoul, Korea
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Suhng Wook Kim
- School of Health and Environmental Science, Korea University, Seoul, Korea
| | - Min Woo Lee
- Research Institute of Health Science, Korea University, Seoul, South Korea
| | | | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jae Kyeong Byun
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jinah Cha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Joo Oh
- Cardiovascular Intervention Research Institute, Seoul, Korea
| | - Sunghoi Hong
- Department of Integrated Biomedical and Life Sciences, Korea University Graduate School, Seoul, Korea
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Hubert A, Seitz A, Pereyra VM, Bekeredjian R, Sechtem U, Ong P. Coronary Artery Spasm: The Interplay Between Endothelial Dysfunction and Vascular Smooth Muscle Cell Hyperreactivity. Eur Cardiol 2020; 15:e12. [PMID: 32373185 PMCID: PMC7199189 DOI: 10.15420/ecr.2019.20] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 12/13/2022] Open
Abstract
Patients with angina pectoris, the cardinal symptom of myocardial ischaemia, yet without significant flow-limiting epicardial artery stenosis represent a diagnostic and therapeutic challenge. Coronary artery spasm (CAS) is an established cause for anginal chest pain in patients with angiographically unobstructed coronary arteries. CAS may occur at the epicardial level and/or in the microvasculature. Although the underlying pathophysiological mechanisms of CAS are still largely unclear, endothelial dysfunction and vascular smooth muscle cell (VSMC) hyperreactivity seem to be involved as major players, although their contribution to induce CAS is still seen as controversial. This article will look at the role and possible mechanistic interplay between an impaired endothelial and VSMC function in the pathogenesis of CAS.
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Affiliation(s)
- Astrid Hubert
- Robert-Bosch-Krankenhaus, Department of Cardiology Stuttgart, Germany
| | - Andreas Seitz
- Robert-Bosch-Krankenhaus, Department of Cardiology Stuttgart, Germany
| | | | - Raffi Bekeredjian
- Robert-Bosch-Krankenhaus, Department of Cardiology Stuttgart, Germany
| | - Udo Sechtem
- Robert-Bosch-Krankenhaus, Department of Cardiology Stuttgart, Germany
| | - Peter Ong
- Robert-Bosch-Krankenhaus, Department of Cardiology Stuttgart, Germany
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12
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Park J, Kim HK, Park EA, Park JB, Lee SP, Lee W, Kim YJ, Sohn DW. Coronary Computed Tomography Angiography for the Diagnosis of Vasospastic Angina: Comparison with Invasive Coronary Angiography and Ergonovine Provocation Test. Korean J Radiol 2020; 20:719-728. [PMID: 30993923 PMCID: PMC6470084 DOI: 10.3348/kjr.2018.0847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/11/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. MATERIALS AND METHODS Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAG-EPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. RESULTS Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m², and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. CONCLUSION For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.
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Affiliation(s)
- Jiesuck Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyung Kwan Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
| | - Eun Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.
| | - Jun Bean Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Seung Pyo Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yong Jin Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Dae Won Sohn
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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13
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Waterbury TM, Tarantini G, Vogel B, Mehran R, Gersh BJ, Gulati R. Non-atherosclerotic causes of acute coronary syndromes. Nat Rev Cardiol 2019; 17:229-241. [DOI: 10.1038/s41569-019-0273-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
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14
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The association of chronic air pollutants with coronary artery spasm, vasospastic angina, and endothelial dysfunction. Coron Artery Dis 2019; 29:336-343. [PMID: 29334505 DOI: 10.1097/mca.0000000000000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND We evaluated the effect of chronic exposure to air pollutants (APs) on coronary endothelial function and significant coronary artery spasm (CAS) as assessed by intracoronary acetylcholine (ACH) provocation test. PATIENTS AND METHODS A total of 6430 patients with typical or atypical chest pain who underwent intracoronary ACH provocation test were enrolled. We obtained data on APs from the Korean National Institute of Environmental Research (http://www.nier.go.kr/). APs are largely divided into two types: particulate matter with aerodynamic diameter of less than or equal to 10 µm in size (PM10) and gaseous pollutants such as nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone. The primary endpoint is the incidence of significant CAS and its associated parameters during ACH provocation test. RESULTS The incidence of CAS was positively correlated with an exposure duration of PM10, whereas nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone were shown to be unrelated to CAS. During the ACH provocation test, as PM10 increased, the frequency of CAS was increased, and the incidence of transient ST-segment elevation was also increased. There was a trend toward higher incidence of spontaneous spasm as PM10 increased. The mean exposure level of PM10 was 51.3±25.4 µg/m. The CAS risk increased by 4% when the level of PM10 increased by 20 µg/m by an adjusted Cox regression analysis. CONCLUSION CAS incidence is closely related to exposure to PMs but not to gaseous pollutants. Particularly, higher exposure concentrations and longer exposure duration of PM10 increased the risk of CAS. These important findings provide a plausible mechanism that links air pollution to vasospastic angina and provide new insights into environmental factors.
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15
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Teragawa H, Oshita C, Ueda T. Coronary spasm: It’s common, but it’s still unsolved. World J Cardiol 2018; 10:201-209. [PMID: 30510637 PMCID: PMC6259026 DOI: 10.4330/wjc.v10.i11.201] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/21/2018] [Accepted: 10/07/2018] [Indexed: 02/06/2023] Open
Abstract
Coronary spasm is caused by a transient coronary narrowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provocation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina (VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm (intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.
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Affiliation(s)
- Hiroki Teragawa
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Chikage Oshita
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
| | - Tomohiro Ueda
- Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
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16
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Park SH, Choi BG, Rha SW, Kang TS. The multi-vessel and diffuse coronary spasm is a risk factor for persistent angina in patients received anti-angina medication. Medicine (Baltimore) 2018; 97:e13288. [PMID: 30461639 PMCID: PMC6392675 DOI: 10.1097/md.0000000000013288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Coronary artery spasm (CAS) is known to be a risk factor for cardiovascular events. However, there is limited data whether the multi-vessel and diffuse spasm (MVDS) is related to more adverse clinical outcomes compared to the Non-MVDS. The aim of this study is to evaluate the impact of the MVDS on clinical outcomes during a 3-year clinical follow-up period.A total 2797 patients underwent coronary angiography (CAG) with acetylcholine (ACH) provocation test from Nov 2004 to Oct 2010 were enrolled. It is a single-center, observational, prospective, all-comers registry designed to reflect the "real world" practic. The patients were divided into the 3 groups; the negative spasm (NS) group (n = 1188), the Non-MVDS group (n = 1081), and the MVDS group (n = 528). The incidence of major adverse cardiac events (MACE) and recurrent angina was evaluated up to 3 years. To minimize confounding factors, multivariable Cox-proportional hazards regression analysis was performed.In the 3-year clinical follow-up, the incidence of total death, myocardial infarction, de novo percutaneous coronary intervention (PCI), cerebrovascular accident and MACE were similar among the 3 groups. However, recurrent angina occurred more frequently in the MVDS group than in the NS group (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.27-3.02; P = .002). Recurrence angina between the MVDS group and the Non-MVDS group was not statistically significant (HR, 1.36; 95% CI, 0.91-2.03; P = .129).In this study, although the incidence of major adverse cardiovascular events were not different regardless of spasm type, the MVDS was associated with higher incidence of recurrent chest pain requiring repeat CAG during the 3-year follow-up period, suggesting more intensive optimal medical therapy with close clinical follow up would be necessary for this particular subset of patients.
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Affiliation(s)
- Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan
| | - Byoung Geol Choi
- Department of Medicine, Korea University Graduate School, Seoul
- Cardiovascular Center, Korea University Guro Hospital, Seoul
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul
| | - Tae Soo Kang
- Cardiovascular Division, Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
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Kang KW, Choi BG, Rha SW. Impact of Insulin Resistance on Acetylcholine-Induced Coronary Artery Spasm in Non-Diabetic Patients. Yonsei Med J 2018; 59:1057-1063. [PMID: 30328320 PMCID: PMC6192881 DOI: 10.3349/ymj.2018.59.9.1057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/29/2018] [Accepted: 08/31/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Coronary artery spasm (CAS) and diabetes mellitus (DM) are implicated in endothelial dysfunction, and insulin resistance (IR) is a major etiological cause of type 2 DM. However, the association between CAS and IR in non-diabetic individuals has not been elucidated. The aim of the present study was to evaluate the impact of IR on CAS in patients without DM. MATERIALS AND METHODS A total of 330 eligible patients without DM and coronary artery disease who underwent acetylcholine (Ach) provocation test were enrolled in this study. Inclusion criteria included both hemoglobin A1c <6.0% and fasting glucose level <110 mg/dL without type 2 DM. Patients were divided into quartile groups according the level of homeostasis model assessment of insulin resistance (HOMA-IR): 1Q (n=82; HOMA-IR<1.35), 2Q (n=82; 1.35≤HOMA-IR<1.93), 3Q (n=83; 1.93≤HOMA-IR< 2.73), and 4Q (n=83; HOMA-IR≥2.73). RESULTS In the present study, the higher HOMA-IR group (3Q and 4Q) was older and had higher body mass index, fasting blood glucose, serum insulin, hemoglobin A1c, total cholesterol, and triglyceride levels than the lower HOMA-IR group (1Q). Also, poor IR (3Q and 4Q) was considerably associated with frequent CAS. Compared with Q1, the hazard ratios for Q3 and Q4 were 3.55 (95% CI: 1.79-7.03, p<0.001) and 2.12 (95% CI: 1.07-4.21, p=0.031), respectively, after adjustment of baseline risk confounders. Also, diffuse spasm and accompanying chest pain during Ach test were more strongly associated with IR patients with CAS. CONCLUSION HOMA-IR was significantly negatively correlated with reference diameter measured after nitroglycerin and significantly positively correlated with diffuse spasm and chest pain.
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Affiliation(s)
- Kwan Woo Kang
- Department of Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byoung Geol Choi
- Research Institute of Health Sciences, Korea University College of Health Science, Seoul, Korea
| | - Seung Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
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18
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Montone RA, Niccoli G, Vergni F, Vetrugno V, Russo M, Mangiacapra F, Fracassi F, Porto I, Leone AM, Burzotta F, D'Amario D, Aurigemma C, Trani C, Lanza GA, Crea F. Endothelial dysfunction as predictor of angina recurrence after successful percutaneous coronary intervention using second generation drug eluting stents. Eur J Prev Cardiol 2018; 25:1360-1370. [PMID: 29785885 DOI: 10.1177/2047487318777435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The role of endothelial dysfunction in predicting angina recurrence after percutaneous coronary intervention is unknown. Design We assessed the role of peripheral endothelial dysfunction measured by reactive-hyperaemia peripheral-artery tonometry (RH-PAT) in predicting recurrence of angina after percutaneous coronary intervention. Methods We enrolled consecutive patients undergoing percutaneous coronary intervention with second-generation drug-eluting stents. RH-PAT was measured at discharge. The endpoint was repeated coronary angiography for angina recurrence and/or evidence of myocardial ischaemia at follow-up. Patients with in-stent restenosis and/or significant de novo stenosis were defined as having angina with obstructed coronary arteries (AOCA); all other patients as having angina with non-obstructed coronary arteries (ANOCA). Results Among 100 patients (mean age 66.7 ± 10.4 years, 80 (80.0%) male, median follow-up 16 (3-20) months), AOCA occurred in 14 patients (14%), ANOCA in nine patients (9%). Repeated coronary angiography occurred more frequently among patients in the lower RH-PAT index tertile compared with middle and upper tertiles (14 (41.2%) vs. 6 (18.2%) vs. 3 (9.1%), p = 0.006, respectively). ANOCA was more frequent in the lower RH-PAT index tertile compared with middle and upper tertiles. In the multivariate regression analysis, the RH-PAT index only predicted angina recurrence. The receiver operating characteristic curve of the RH-PAT index to predict the angina recurrence demonstrated an area under the curve of 0.79 (95% confidence interval: 0.69-0.89; p < 0.001), with a cut-off value of 1.705, having sensitivity 74% and specificity 70%. Conclusions Non-invasive assessment of peripheral endothelial dysfunction using RH-PAT might help in the prediction of recurrent angina after percutaneous coronary intervention, thus identifying patients who may need more intense pharmacological treatment and risk factor control.
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Affiliation(s)
- Rocco A Montone
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giampaolo Niccoli
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Federico Vergni
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Vetrugno
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Russo
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Fabio Mangiacapra
- 2 Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Francesco Fracassi
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Italo Porto
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio M Leone
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico D'Amario
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina Aurigemma
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano A Lanza
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- 1 Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Kim H, Cho SH, Cho KI, Kim BJ, Im SI, Heo JH. Blunted heart rate recovery is associated with coronary artery spasm in patients with suspected vasospastic angina. Clin Hypertens 2017; 23:24. [PMID: 29238609 PMCID: PMC5725649 DOI: 10.1186/s40885-017-0080-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022] Open
Abstract
Background Autonomic nervous system activity has been shown to be altered in patients with vasospastic angina (VA). Heart rate recovery (HRR) is a simple, non-invasive measurement of autonomic nervous system dysfunction. We aimed to investigate whether HRR is related to VA, as established by an ergonovine test. Methods A total of 976 consecutive patients (47.5% male, mean age 55 years) without significant coronary artery disease who underwent both an ergonovine provocation test and a treadmill exercise test were enrolled. The relationship between VA and HRR was evaluated. Results A total of 30.7% (300/976) of patients were diagnosed with VA, as documented by the ergonovine provocation test. HRR was significantly reduced in patients with VA compared to patients without VA (24.6 ± 18.0 vs. 30.5 ± 22.2, p < 0.001), and HRR was lowest in patients with multi-vessel spasm (21.9 ± 17.3). The proportion of blunted HRR, which was defined as HRR less than 12 beats, was significantly higher in patients with VA than in those without coronary artery spasm (26.6% vs. 39.3%, p < 0.001). In multivariable regression analyses, age (odds ratio (OR) = 1.03; 95% confidence interval (CI): 1.01–1.04; p = 0.001), blunted HRR (OR = 1.71; 95% CI: 1.26–2.31; p < 0.001), current smoking status (OR = 2.11; 95% CI: 1.50–2.98; p < 0.001), and male gender (OR = 2.00; 95% CI: 1.43–2.78; p < 0.001) were significant independent predictors of VA presence. Conclusion Blunted HRR was an independent predictor of VA presence, which suggests a link between coronary artery spasm and autonomic dysregulation.
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Affiliation(s)
- Hyunsu Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan, 602-702 Korea
| | - Sang-Hoon Cho
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan, 602-702 Korea
| | - Bong-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan, 602-702 Korea
| | - Sung-Il Im
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan, 602-702 Korea
| | - Jung-Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, 34, Amnam-dong, Seo-gu, Busan, 602-702 Korea
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Choi BG, Park SH, Rha SW, Ahn J, Choi SY, Byun JK, Li H, Mashaly A, Shim MS, Kang JH, Kim W, Choi JY, Park EJ, Lee S, Na JO, Choi CU, Lim HE, Kim EJ, Park CG, Seo HS, Oh DJ. Three-year follow-up of patients with acetylcholine-induced coronary artery spasm combined with insignificant coronary stenosis. Int J Cardiol 2017; 238:66-71. [DOI: 10.1016/j.ijcard.2017.03.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 03/10/2017] [Accepted: 03/16/2017] [Indexed: 11/27/2022]
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21
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Choi BG, Rha SW, Park T, Choi SY, Byun JK, Shim MS, Xu S, Li H, Park SH, Park JY, Choi WG, Cho YH, Lee S, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Park CG, Seo HS, Oh DJ. Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients. Korean Circ J 2016; 46:632-638. [PMID: 27721853 PMCID: PMC5054174 DOI: 10.4070/kcj.2016.46.5.632] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. Subjects and Methods A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years. Results There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021). Conclusion Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.
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Affiliation(s)
- Byoung Geol Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Taeshik Park
- Department of General Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Min Suk Shim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Shaopeng Xu
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hu Li
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Sang-Ho Park
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ji Young Park
- Cardiovascular Center, Eulji University, Eulji General Hospital, Seoul, Korea
| | - Woong Gil Choi
- Cardiovascular Center, Chungju Kunkuk University, Chungju, Korea
| | - Yun-Hyeong Cho
- Cardiovascular Center, Seonam University, Myongji Hospital, Goyang, Korea
| | - Sunki Lee
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Euy Lim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Won Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Saitoh SI, Takeishi Y, Maruyama Y. MECHANISTIC INSIGHTS OF CORONARY VASOSPASM AND NEW THERAPEUTIC APPROACHES. Fukushima J Med Sci 2015; 61:1-12. [PMID: 26063511 DOI: 10.5387/fms.2015-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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23
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Choi BG, Park SH, Rha SW, Park JY, Choi SY, Park Y, Xu S, Ngow HA, Ali J, Li H, Kim JB, Lee S, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Park CG, Seo HS, Oh DJ. Five-year clinical outcomes in patients with significant coronary artery spasm: A propensity score-matched analysis. Int J Cardiol 2015; 184:533-539. [DOI: 10.1016/j.ijcard.2015.02.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/13/2015] [Accepted: 02/21/2015] [Indexed: 11/24/2022]
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Lee SW, Cho KI, Kim HS, Heo JH, Cha TJ. The Impact of Subclinical Hypothyroidism or Thyroid Autoimmunity on Coronary Vasospasm in Patients without Associated Cardiovascular Risk Factors. Korean Circ J 2015; 45:125-30. [PMID: 25810734 PMCID: PMC4372978 DOI: 10.4070/kcj.2015.45.2.125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/07/2014] [Accepted: 11/14/2014] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Subclinical hypothyroidism is associated with endothelial dysfunction and impaired coronary flow reserve. However, the effect of subclinical hypothyroidism or thyroid autoimmunity on variant angina has yet to be determined. Subjects and Methods Among 385 consecutive patients without associated cardiovascular risk factors who underwent coronary angiography with the ergonovine provocation test (EPT), 165 had a positive EPT {EPT(+)} and 220 had a negative EPT {EPT(-)}. The relationship between coronary artery spasm and the presence of subclinical thyroid dysfunction as well as serum thyroid peroxidase autoantibody (TPO Ab) was evaluated. Results The proportion of patients with subclinical hypothyroidism among those who were EPT(+) was significantly higher than that in those who were EPT(-) (18% vs. 11%, p=0.001). However, there was no significant difference in the proportion of patients with subclinical hyperthyroidism between the groups. Moreover, EPT(+) patients showed significantly more positive TPO Ab (33% vs. 14%, p<0.001) than those with EPT(-). There was a positive correlation between EPT(+) and TPO positivity (r=0.226, p<0.001), subclinical hypothyroidism (r=0.112, p=0.033), and body mass index (r=0.123, p=0.018). Binary logistic regression analysis revealed that the significant predictors of EPT(+) were body mass index {adjusted odds ratio (OR)=1.042, 95% confidence interval (CI)=1.005-1.080}, presence of subclinical hypothyroidism (OR=3.047, 95% CI=1.083-8.572), TPO Ab titer (OR=1.028, 95% CI=1.015-1.041), and the presence of TPO Ab (OR=4.904, 95% CI=1.544-15.567). Conclusion Subclinical hypothyroidism and the presence of TPO Ab are significantly associated with coronary vasospasm in patients without cardiovascular risk factors.
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Affiliation(s)
- Sea-Won Lee
- Division of Cardiology, Department of Internal Medicine, Busan Veterans Hospital, Busan, Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hyun-Su Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jung-Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Tae-Joon Cha
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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25
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Increased levels of the oxidative stress marker, nitrotyrosine in patients with provocation test-induced coronary vasospasm. J Cardiol 2014; 64:86-90. [DOI: 10.1016/j.jjcc.2013.11.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 10/27/2013] [Accepted: 11/30/2013] [Indexed: 11/24/2022]
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Parrinello R, Sestito A, Di Franco A, Russo G, Villano A, Figliozzi S, Nerla R, Tarzia P, Stazi A, Lanza GA, Crea F. Peripheral Arterial Function and Coronary Microvascular Function in Patients with Variant Angina. Cardiology 2014; 129:20-4. [DOI: 10.1159/000362380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022]
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Yamada S, Saitoh SI, Machii H, Mizukami H, Hoshino Y, Misaka T, Ishigami A, Takeishi Y. Coronary artery spasm related to thiol oxidation and senescence marker protein-30 in aging. Antioxid Redox Signal 2013; 19:1063-73. [PMID: 23320823 PMCID: PMC3771551 DOI: 10.1089/ars.2012.4903] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Senescence marker protein-30 (SMP30) decreases with aging, and SMP30 knockout (KO) mice show a short life with increased oxidant stress. AIMS We assessed the effect of oxidant stress with SMP30 deficiency in coronary artery spasm and clarify its underlying mechanisms. RESULTS We measured vascular responses to acetylcholine (ACh) and sodium nitroprusside (SNP) of isolated coronary arteries from SMP30 KO and wild-type (WT) mice. In SMP30 KO mice, ACh-induced vasoconstriction occurred, which was changed to vasodilation by dithiothreitol (DTT), a thiol-reducing agent. However, Nω-nitro-L-arginine-methyl ester, nitric oxide (NO) synthase inhibitor, or tetrahydrobiopterin did not change the ACh response. In isolated coronary arteries of WT mice, ACh-induced vasodilation occurred. Inhibition of glutathione reductase by 1, 3-bis(2-chloroethyl)-1-nitrosourea decreased ACh-induced vasodilation (n=10, p<0.01), which was restored by DTT. To evaluate the thiol oxidation, we measured the fluorescence of monochlorobimane (MCB) in coronary arteries, which covalently labels the total. The fluorescence level to MCB decreased in SMP30 KO mice, but with DTT treatment restored to a level comparable to that of WT mice. The reduced glutathione and total thiol levels were also low in the aorta of SMP30 KO mice compared with those of WT mice. Administration of ACh into the aortic sinus in vivo of SMP30 KO mice induced coronary artery spasm. INNOVATION The thiol redox state is a key regulator of endothelial NO synthase activity, and thiol oxidation was associated with endothelial dysfunction in the SMP30 deficiency model. CONCLUSION These results suggest that chronic thiol oxidation by oxidant stress is a trigger of coronary artery spasm, resulting in impaired endothelium-dependent vasodilation.
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Affiliation(s)
- Shinya Yamada
- 1 Department of Cardiology and Hematology, Fukushima Medical University , Fukushima, Japan
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Nishino M, Mori N, Yoshimura T, Nakamura D, Lee Y, Taniike M, Makino N, Kato H, Egami Y, Shutta R, Tanouchi J, Yamada Y. Higher serum uric acid and lipoprotein(a) are correlated with coronary spasm. Heart Vessels 2013; 29:186-90. [PMID: 23552902 DOI: 10.1007/s00380-013-0346-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/22/2013] [Indexed: 12/22/2022]
Abstract
It has been reported that a major cause of coronary vasospastic angina (VSA) is endothelial dysfunction of the coronary artery. On the other hand, some studies showed that serum uric acid and lipoprotein(a) are correlated with endothelial dysfunction. Thus, we examined whether uric acid and lipoprotein(a), are correlated with VSA. Four hundred forty-one patients with suspected VSA who underwent a coronary angiogram with acetylcholine provocation (ACh test) during an 8-year period were enrolled. We divided them into a VSA group, who showed coronary spasm by the ACh test, and an atypical chest pain (ACP) group, who showed negative ACh test. We compared serum markers between the two groups, including low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a), fibrinogen, total plasminogen activator inhibitor-1, and uric acid. Uric acid, hs-CRP, and lipoprotein(a) were significantly higher in the VSA group than in the ACP group (all P < 0.05) while there were no significant differences in the other parameters. Multivariate analyses identified uric acid and lipoprotein(a) as significant independent markers for VSA. Uric acid and lipoprotein(a) are correlated with VSA, and medical intervention to decrease uric acid and lipoprotein(a) might be effective in controlling VSA.
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Affiliation(s)
- Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan,
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Teragawa H, Mitsuba N, Ishibashi K, Nishioka K, Kurisu S, Kihara Y. Evaluation of coronary microvascular function in patients with vasospastic angina. World J Cardiol 2013; 5:1-7. [PMID: 23390571 PMCID: PMC3565162 DOI: 10.4330/wjc.v5.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/30/2012] [Accepted: 01/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate endothelium-dependent and -independent coronary microvascular functions in patients with vasospastic angina (VSA).
METHODS: Thirty-six patients with VSA (30 men and 6 women; mean age, 58 years) were enrolled in this study. VSA was defined as ≥ 90% narrowing of the epicardial coronary arteries on angiography performed during a spasm provocation test, presence of chest pain, and/or ST-segment deviation on an electrocardiogram (ECG). Patients (n = 36) with negative spasm provocation test results and those matched for age and sex were enrolled as a control group (nonVSA group). Low-dose acetylcholine (ACh; 3 μg/min) was infused into the left coronary ostium for 2 min during the spasm provocation test. Following the spasm provocation test, nitroglycerin (0.2 mg) was administered intracoronally. Coronary blood flow (was calculated from quantitative angiography and Doppler flow velocity measurements, and the coronary flow reserve was calculated as the ratio of coronary flow velocity after injection of adenosine triphosphate (20 μg) to the baseline value. Changes in the coronary artery diameter in response to ACh and nitroglycerin infusion were expressed as percentage changes from baseline measurements.
RESULTS: Body mass index was significantly lower in the VSA group than in the nonVSA group. The frequency of conventional coronary risk factors and the rate of statin use were similar between the 2 groups. The left ventricular ejection fraction as evaluated by echocardiography was similar between the 2 groups. The duration of angina was 9 ± 2 mo. The results of blood chemistry analysis were similar between the 2 groups. Low-dose ACh did not cause coronary spasms. The change in coronary artery diameter in response to ACh was lower in the VSA group (-1.4% ± 9.3%) than in the nonVSA group (3.1% ± 6.5%, P < 0.05), whereas nitroglycerin-induced coronary artery dilatation and coronary blood flow increase in response to ACh or coronary flow reserve did not differ significantly between the 2 groups.
CONCLUSION: These findings suggest that microvascular coronary function may be preserved despite endothelial dysfunction of the epicardial coronary arteries in patients with VSA.
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Ohba K, Sugiyama S, Sumida H, Nozaki T, Matsubara J, Matsuzawa Y, Konishi M, Akiyama E, Kurokawa H, Maeda H, Sugamura K, Nagayoshi Y, Morihisa K, Sakamoto K, Tsujita K, Yamamoto E, Yamamuro M, Kojima S, Kaikita K, Tayama S, Hokimoto S, Matsui K, Sakamoto T, Ogawa H. Microvascular coronary artery spasm presents distinctive clinical features with endothelial dysfunction as nonobstructive coronary artery disease. J Am Heart Assoc 2012; 1:e002485. [PMID: 23316292 PMCID: PMC3541613 DOI: 10.1161/jaha.112.002485] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/02/2012] [Indexed: 12/22/2022]
Abstract
Background Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Methods and Results Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular CAS according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular CAS who demonstrated significant impairment of the endothelium-dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular CAS. Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor–borderline ischemic electrocardiogram findings at rest, limited–baseline diastolic-to-systolic velocity ratio, and attenuated adenosine triphosphate–induced coronary flow reserve were independently correlated with the presence of microvascular CAS. Receiver-operating characteristics curve analysis revealed that the aforementioned 5-variable model showed good correlation with the presence of microvascular CAS (area under the curve: 0.820). No patients with microvascular CAS treated with calcium channel blockers developed cardiovascular events over 47.8±27.5 months. Conclusions Microvascular CAS causes distinctive clinical features and endothelial dysfunction that are important to recognize as nonobstructive coronary artery disease so that optimal care with calcium channel blockers can be provided. Clinical Trial Registration URL: www.umin.ac.jp/ctr. Unique identifier: UMIN000003839.
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Affiliation(s)
- Keisuke Ohba
- Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Jagiasi B, Nasa P, Dash D. Chest pain with ST-T changes on electrocardiogram and localized stenosis on coronary angiography could be a coronary vasospasm. J Cardiovasc Dis Res 2012. [PMID: 22629040 DOI: 10.4103/0975-3583.95376.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coronary vasospasm is characterized by chest pain at rest with ST-T changes on electro cardiogram and coronary angiography showing virtually normal coronaries. The definitive diagnosis requires the stimulation of coronary vasospasm using provocative agents, which can be life threatening. We present a case where localized stenosis of proximal left anterior descending artery was observed on the coronary angiography, which disappeared on subsequent views, and hence, coronary stenting was deferred and patient responded well to medical management alone.
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Affiliation(s)
- Bharat Jagiasi
- Department of Critical Care Medicine, Fortis Raheja Hospital, Mumbai, India
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Impairment of the extrusion transporter for asymmetric dimethyl-L-arginine: a novel mechanism underlying vasospastic angina. Biochem Biophys Res Commun 2012; 423:218-23. [PMID: 22609206 DOI: 10.1016/j.bbrc.2012.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/09/2012] [Indexed: 11/21/2022]
Abstract
A 37-year old male patient presented with frequent angina attacks (up to 40/day) largely resistant to classical vasodilator therapy. The patient showed severe coronary and peripheral endothelial dysfunction, increased platelet aggregation and increased platelet-derived superoxide production. The endothelial nitric oxide synthase (eNOS)-inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) reduced superoxide formation in platelets identifying "uncoupled" eNOS as a superoxide source. Oral L-arginine normalized coronary and peripheral endothelial dysfunction and reduced platelet aggregation and eNOS-derived superoxide production. Plasma concentrations of the endogenous NOS inhibitor asymmetric dimethyl-L-arginine (ADMA), representing an independent risk factor for cardiovascular disease, were normal in the patient. However, immediately after oral administration of cationic amino acid (CAA), plasma ADMA levels rose markedly, demonstrating increased ADMA efflux from intracellular stores. ADMA efflux from mononuclear cells of the patient was accelerated by CAA, but not neutral amino acids (NAA) demonstrating impairment of y(+)LAT (whose expression was found reduced in these cells). These data suggest that impairment of y(+)LAT may cause intracellular (endothelial) ADMA accumulation leading to systemic endothelial dysfunction. This may represent a novel mechanism underlying vasospastic angina and vascular dysfunction in general. Moreover, these new findings contribute to the understanding of the l-arginine paradox, the improvement of eNOS activity by oral L-arginine despite sufficient cellular l-arginine levels to ensure proper function of this enzyme.
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Jagiasi B, Nasa P, Dash D. Chest pain with ST-T changes on electrocardiogram and localized stenosis on coronary angiography could be a coronary vasospasm. J Cardiovasc Dis Res 2012; 3:165-6. [PMID: 22629040 PMCID: PMC3354465 DOI: 10.4103/0975-3583.95376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Coronary vasospasm is characterized by chest pain at rest with ST-T changes on electro cardiogram and coronary angiography showing virtually normal coronaries. The definitive diagnosis requires the stimulation of coronary vasospasm using provocative agents, which can be life threatening. We present a case where localized stenosis of proximal left anterior descending artery was observed on the coronary angiography, which disappeared on subsequent views, and hence, coronary stenting was deferred and patient responded well to medical management alone.
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Affiliation(s)
- Bharat Jagiasi
- Department of Critical Care Medicine, Fortis Raheja Hospital, Mumbai, India
| | - Prashant Nasa
- Department of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
- Address for correspondence:Dr. Prashant Nasa, 71/9 1st Floor, Prem Nagar, Janakpuri, New Delhi, India. E-mail:
| | - Debabrata Dash
- Department of Cardiology, Fortis Raheja Hospital, Mumbai, India
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Abstract
BACKGROUND Heatstroke can result in significant diffuse tissue derangement, which can result in multiple organ system dysfunction. The heart can equally be affected and ischemia and infarction may occur. OBJECTIVE This study aimed to present the potential complications from heatstroke to the myocardium. CASE A case of a 15-year-old adolescent boy who collapsed after playing football in a hot summer day was found to be hyperthermic and poorly perfused. He had ischemic electrocardiographic changes and elevated cardiac enzymes but with normal coronary arteries. CONCLUSIONS Heatstroke can lead to morbidity and mortality. Tissue damage during heatstroke is believed to result from uncoupling during oxidative phosphorylation. It is important to realize that heart damage can occur from heatstroke and that appropriate diagnostic and therapeutic measures are required for a good outcome.
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Kusama Y, Kodani E, Nakagomi A, Otsuka T, Atarashi H, Kishida H, Mizuno K. Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management. J NIPPON MED SCH 2011; 78:4-12. [PMID: 21389642 DOI: 10.1272/jnms.78.4] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Variant angina is a form of angina pectoris that shows transient ST-segment elevation on electrocardiogram during an attack of chest pain. Ischemic episodes of variant angina show circadian variation and often occur at rest from midnight to early morning. Ischemic episodes also occur during mild exercise in the early morning. However, they are not usually induced by strenuous exercise in the afternoon. Other important clinical features of variant angina include the high frequency of asymptomatic ischemic episodes and the syncope that sometimes occur during the ischemic episodes. Syncope is due to severe arrhythmias, including ventricular tachycardia, ventricular fibrillation, and high-degree atrioventricular block. Coronary artery spasm is the mechanism of ischemic episodes in variant angina. The incidence of coronary artery spasm shows a racial difference and is higher in Japanese than in Caucasians. Coronary arteriograms are normal or near-normal in most Japanese patients with variant angina. Deficient basal release of nitric oxide (NO) due to endothelial dysfunction, and enhanced vascular smooth muscle contractility with the involvement of the Rho/Rho-kinase pathway are reported to play important roles in the pathogenesis of coronary artery spasm. Other precipitating factors of coronary artery spasm include imbalance in autonomic nervous activity, increased oxidative stress, chronic low-grade inflammation, magnesium deficiency, and genetic susceptibility. The genetic risk factors associated with coronary artery spasm include gene polymorphisms of endothelial NO synthase (NOS), paraoxonase, and other genes. Calcium channel blockers are extremely effective in preventing coronary spasm. The long-acting nitrate, nicorandil, and Rho-kinase inhibitor are also useful for inhibiting coronary artery spasm. Because variant angina can lead to acute myocardial infarction, fatal arrhythmias, and sudden death, early treatment is important. The prognosis of patients with variant angina is favorable, if early complications can be overcome. However, because coronary artery spasm cannot be suppressed in some patients, even with multiple medications, medications to suppress intractable coronary artery spasm must be developed.
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Affiliation(s)
- Yoshiki Kusama
- Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Department of Internal Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Funayama A, Watanabe T, Tamabuchi T, Otaki Y, Netsu S, Hasegawa H, Honda S, Ishino M, Arimoto T, Takahashi H, Shishido T, Miyamoto T, Nitobe J, Kubota I. Elevated Cystatin C Levels Predict the Incidence of Vasospastic Angina. Circ J 2011; 75:2439-44. [DOI: 10.1253/circj.cj-11-0008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akira Funayama
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Toshiaki Tamabuchi
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Yoichiro Otaki
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Shunsuke Netsu
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Hiromasa Hasegawa
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Shintaro Honda
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Mitsunori Ishino
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Takuya Miyamoto
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Joji Nitobe
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Isao Kubota
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
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Abstract
Abnormal coronary vasoconstriction, or coronary spasm, can be the result of several factors, including local and neuroendocrine aberrations. It can manifest clinically as a coronary syndrome and plays an important role in the genesis of myocardial ischemia. Over the past half century, coronary angiography allowed the in vivo demonstration of spasm in patients who fit the initial clinical description of the condition as reported by Prinzmetal et al. Several clinical, basic, and more recently, genetic studies have provided insight into the pathogenesis, manifestations, and therapy of this condition. It is not uncommonly encountered in patients with coronary syndromes and absence of clearly pathologic lesions on angiography. Provocation tests utilizing pharmacologic and nonpharmacologic stimuli combined with imaging (echocardiography or coronary angiography) can help make the correct diagnosis. The use of calcium channel blockers and long-acting nitrates is currently considered standard of care and the overall prognosis appears to be good. The recent discovery of genetic abnormalities predisposing to abnormal spasm of the coronaries has stimulated interest in the development of targeted therapies for the management of this condition.
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Matsuzawa Y, Sugiyama S, Sugamura K, Nozaki T, Ohba K, Konishi M, Matsubara J, Sumida H, Kaikita K, Kojima S, Nagayoshi Y, Yamamuro M, Izumiya Y, Iwashita S, Matsui K, Jinnouchi H, Kimura K, Umemura S, Ogawa H. Digital Assessment of Endothelial Function and Ischemic Heart Disease in Women. J Am Coll Cardiol 2010; 55:1688-96. [DOI: 10.1016/j.jacc.2009.10.073] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 09/24/2009] [Accepted: 10/12/2009] [Indexed: 11/26/2022]
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Interaction between cigarette smoking and high-sensitivity C-reactive protein in the development of coronary vasospasm in patients without hemodynamically significant coronary artery disease. Am J Med Sci 2010; 338:440-6. [PMID: 20010154 DOI: 10.1097/maj.0b013e3181b9147f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interaction between 2 major risk factors, cigarette smoking and high-sensitivity C-reactive protein (hs-CRP), has not been evaluated in patients with coronary vasospasm (CV) without hemodynamically significant coronary artery disease. METHODS From 1999 to 2005, patients undergoing diagnostic coronary angiography with or without proven CV and without coronary stenosis >50% were evaluated. A total of 621 subjects (335 and 286 with and without CV, respectively) were enrolled in the study. The levels of hs-CRP, measured immediately before coronary angiography, were examined in a subset of 314 patients. RESULTS Subjects with CV were likely to be older, men, current smokers, and have high hs-CRP levels. The most significant factors for CV were smoking and hs-CRP. In the nonsmoker group, elevated risk of developing CV was only demonstrated in patients with the highest hs-CRP tertile (>5.01 mg/L, P = 0.012). In the smoker group, however, a positively monotonic trend of association was demonstrated between hs-CRP tertile and CV risk, with multivariate-adjusted odds ratios of 1.11, 3.09 (P = 0.012), and 4.12 by the hs-CRP tertiles, suggesting that smokers developed CV at a lower hs-CRP level than nonsmokers and there was a positive interaction between smoking and hs-CRP. CONCLUSIONS The smokers developed CV at a lower hs-CRP level compared with the nonsmokers. A positive interaction between smoking and hs-CRP was demonstrated for this disease in our study population.
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Eijking D, Reichert C, Wagenvoort A, Van Geel B, Toornvliet A, Honing M. Deadly vasospasm. Resuscitation 2009; 80:1318-20. [DOI: 10.1016/j.resuscitation.2009.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 07/07/2009] [Accepted: 07/16/2009] [Indexed: 11/29/2022]
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41
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Chen KY, Rha SW, Li YJ, Poddar KL, Jin Z, Minami Y, Wang L, Li GP, Saito S, Park JH, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Park CG, Seo HS, Oh DJ. Peripheral arterial disease is associated with coronary artery spasm as assessed by an intracoronary acetylcholine provocation test. Clin Exp Pharmacol Physiol 2009; 36:e78-82. [DOI: 10.1111/j.1440-1681.2009.05273.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Novel pathway of endothelin-1 and reactive oxygen species in coronary vasospasm with endothelial dysfunction. Coron Artery Dis 2009; 20:400-8. [PMID: 19623039 DOI: 10.1097/mca.0b013e32832e5c8c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The role of endothelial dysfunction in coronary vasospasm is controversial. We hypothesized that reactive oxygen species (ROS) and endothelin-1 (ET-1) are plausible candidates as the mediator of vasospasm is linked to endothelial dysfunction. In a pig model with repetitive endothelial injury in coronary arteries, intracoronary administration of serotonin induced a vasospasm at the endothelial injury site. The level of endothelin-converting enzyme was upregulated at that site where, upon exposure to serotonin, there were also increases in p47(phox), ROS, and ET-1 fluorescence intensities, and myosin light chain phosphorylation and RhoA activation were detected. The nicotinamide adenine dinucleotide phosphate oxidase inhibitor, apocynin, had the effect of extinguishing not only ROS but also the appearance of ET-1. The chronic blockade of endothelin type-A receptor prevented a serotonin-triggered vasospasm along with the inhibition of ROS generation and myosin light chain phosphorylation. Under the coronary artery endothelial dysfunction, ET-1 is essential for an ROS-dependent coronary vasospasm. Our findings suggest that endothelial dysfunction plays a critical role in clinically defined human Prinzmetal angina.
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Cho SH, Jeong MH, Park IH, Choi JS, Yoon HJ, Kim KH, Hong YJ, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Endothelial dysfunction, increased carotid artery intima-media thickness and pulse wave velocity, and increased level of inflammatory markers are associated with variant angina. J Cardiol 2009; 54:183-91. [DOI: 10.1016/j.jjcc.2009.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 05/02/2009] [Accepted: 05/08/2009] [Indexed: 11/29/2022]
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Infusino F, Lanza GA, Sestito A, Sgueglia GA, Crea F, Maseri A. Combination of variant and microvascular angina. Clin Cardiol 2009; 32:E40-5. [PMID: 19610123 PMCID: PMC6653756 DOI: 10.1002/clc.20502] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 06/23/2008] [Indexed: 11/11/2022] Open
Abstract
Prinzmetal's variant angina (VA) and cardiac syndrome X (CSX) are two distinct, usually easily recognizable, forms of angina syndromes, caused by epicardial spasm, usually responsible for transient transmural myocardial ischemia at rest and by coronary microvascular dysfunction (CMVD), usually responsible for effort induced subendocardial ischemia, respectively. In this article we report clinical evidence in three patients of the simultaneous occurrence of angina episodes typical of both VA and CSX, suggesting that common pathogenetic factors may be responsible for clinical manifestations both of functional macrovascular and microvascular coronary artery abnormalities in some angina patients.
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Affiliation(s)
- Fabio Infusino
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gaetano A. Lanza
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alfonso Sestito
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Filippo Crea
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Attilio Maseri
- Dipartimento di Cardiologia, Università Vita e Salute, Milano, Italy
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Kajikuri J, Watanabe Y, Ito Y, Ito R, Yamamoto T, Itoh T. Characteristic changes in coronary artery at the early hyperglycaemic stage in a rat type 2 diabetes model and the effects of pravastatin. Br J Pharmacol 2009; 158:621-32. [PMID: 19645710 DOI: 10.1111/j.1476-5381.2009.00348.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Diabetes is a risk factor for the development of coronary artery disease but it is not known whether the functions of endothelium-derived nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF) in coronary arteries are altered in the early stage of diabetes. Such alterations and the effects of pravastatin were examined in left anterior descending coronary arteries (LAD) from Otsuka Long-Evans Tokushima Fatty (OLETF) rats (type 2 diabetes model) at the early hyperglycaemic stage [vs. non-diabetic Long-Evans Tokushima Otsuka (LETO) rats]. EXPERIMENTAL APPROACH Isometric tension, membrane potential and superoxide production were measured, as were protein expression of NAD(P)H oxidase components and endothelial NO synthase (eNOS). KEY RESULTS Superoxide production and the protein expressions of both the nicotinamide adenine dinucleotide (phosphate) [NAD(P)H] oxidase components and eNOS were increased in OLETF rats. These changes were normalized by pravastatin administration. Not only acetylcholine (ACh)-induced endothelial NO production but also functions of endothelium-derived NO [from (i) the absolute tension induced by epithio-thromboxane A(2) (STA(2)) or high K(+); (ii) enhancement of the STA(2)-contraction by a nitric oxide synthase (NOS) inhibitor; and (iii) the ACh-induced endothelium-dependent relaxation of high K(+)-induced contraction] or EDHF [from (iv) ACh-induced endothelium-dependent smooth muscle cell hyperpolarization and relaxation in the presence of a NOS inhibitor] were similar between LETO and OLETF rats [whether or not the latter were pravastatin-treated or -untreated]. CONCLUSIONS AND IMPLICATIONS Under conditions of increased vascular superoxide production, endothelial function is retained in LAD in OLETF rats at the early hyperglycaemic stage, partly due to enhanced endothelial NOS protein expression. Inhibition of superoxide production may contribute to the beneficial vascular effects of pravastatin.
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Affiliation(s)
- J Kajikuri
- Department of Pharmacology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
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Chen KY, Rha SW, Li YJ, Poddar KL, Jin Z, Minami Y, Saito S, Park JH, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Park CG, Seo HS, Oh DJ. Impact of hypertension on coronary artery spasm as assessed with intracoronary acetylcholine provocation test. J Hum Hypertens 2009; 24:77-85. [PMID: 19458625 PMCID: PMC3011093 DOI: 10.1038/jhh.2009.40] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Both hypertension and coronary artery spasm (CAS) are associated with endothelial dysfunction. Thus, a higher incidence of CAS is expected in hypertensive patients. We evaluated the impact of hypertension on CAS with intracoronary acetylcholine (ACh) provocation test. A total of 986 patients (685 hypertensive patients vs 301 normotensive patients) who underwent coronary angiography with ACh provocation test were enrolled. ACh was injected into the left coronary artery in incremental doses of 20, 50 and 100 microg min(-1). Significant CAS was defined as a transient >70% luminal narrowing with concurrent chest pain and/or ST-segment changes. Although the incidences of significant ACh-induced CAS were similar between hypertensive and normotensive patients (35.8 vs 39.2%, P=0.303), multivariate logistic analysis showed that hypertension was negatively associated with ACh-induced CAS (odds ratio: 0.70, 95% confidence interval: 0.51-0.94, P=0.020). The angiographic characteristics of ACh-induced CAS were similar between these two groups. Subgroup analysis regarding the impact of the status of blood pressure control on CAS showed that hypertensive patients with controlled blood pressure had a significantly higher incidence of CAS than those with uncontrolled blood pressure (45.2 vs 27.9%, P<0.001), and that uncontrolled blood pressure was negatively associated with ACh-induced CAS (odds ratio: 0.56, 95% confidence interval: 0.40-0.79, P=0.001). In conclusion, despite the expected endothelial dysfunction, hypertension and uncontrolled blood pressure are negatively associated with CAS, suggesting that the mechanisms and risk factors of CAS may be significantly different from those of coronary artery disease.
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Affiliation(s)
- K-Y Chen
- Department of Internal Medicine, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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Is ED Still Only Equal to ED? Eur Urol 2009; 55:794-7; discussion 797-800. [DOI: 10.1016/j.eururo.2008.08.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 08/26/2008] [Indexed: 11/23/2022]
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Miwa Y, Masai H, Shimizu M. Differential Effects of Calcium-Channel Blockers on Vascular Endothelial Function in Patients With Coronary Spastic Angina. Circ J 2009; 73:713-7. [DOI: 10.1253/circj.cj-08-0188] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoichi Miwa
- Department of Internal Medicine, National Hospital Organization Kobe Medical Center
| | - Hiroyuki Masai
- Department of Cardiology, National Hospital Organization Kobe Medical Center
| | - Masatoshi Shimizu
- Department of Cardiology, National Hospital Organization Kobe Medical Center
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Increased peripheral circulating inflammatory cells and plasma inflammatory markers in patients with variant angina. Coron Artery Dis 2008; 19:293-7. [PMID: 18607165 DOI: 10.1097/mca.0b013e3282fd5c4e] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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B-type natriuretic peptide after hormone therapy in postmenopausal women with chest pain and normal coronary angiogram. Menopause 2008; 15:352-6. [DOI: 10.1097/gme.0b013e31806548f6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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