Diagnosis of coronary artery spasm by ergonovine provocation test of radial artery

Vasospastic Angina in a Young Woman: A Case Report

Vasospastic angina (VSA) is a disease that causes myocardial ischemia due to transient vasoconstriction of the epicardial coronary arteries. This disease generally occurs in middle-aged and older adults, but there are also reports of it occurring in young people. We report a case of VSA in a woman in her 20's. Six months ago, a female patient in her 20s became aware of a strangling sensation in the chest that lasted for approximately 1-20 minutes at rest or during stress. She consulted her family doctor who prescribed nitroglycerin sublingual tablets, which were effective. She was a current smoker and had a history of bronchial asthma, with no family history of coronary artery disease. Resting electrocardiogram and echocardiography revealed no clear abnormalities. The patient was referred to our hospital for coronary angiography (CAG) and spasm provocation test (SPT), primarily to thoroughly examine her chest pain at rest. CAG revealed no significant stenosis. A subsequent SPT using acetylcholine demonstrated diffuse coronary spasm in the left anterior descending coronary artery (LAD). The coronary spasm resolved spontaneously, but the catheter was difficult to maneuver owing to the radial artery spasm at the puncture site; thus, nitroglycerin was administered, which alleviated the radial artery spasm. Another SPT was performed on the right coronary artery (RCA) and revealed no coronary spasm. Coronary microcirculatory function using a pressure wire in response to the peripheral infusion of adenosine triphosphate was assessed in the RCA and LAD, both of which were normal. The patient was discharged from the hospital on an oral calcium channel blocker (CCB). She continued to experience chest pain, but her chest symptoms improved with CCB medication and a change in her workplace. It must be kept in mind that coronary spasms can occur even in young women and should be one of the differentials of chest pain in such patients.

Dysregulation Serum miR-19a-3p is a Diagnostic Biomarker for Asymptomatic Carotid Artery Stenosis and a Promising Predictor of Cerebral Ischemia Events

This study aims to identify the diagnostic potential of microRNA-19a-3p (miR-19a-3p) for asymptomatic carotid artery stenosis (CAS) and clinical predictive potential for cerebral ischemia events (CIEs). Serum samples from 101 asymptomatic CAS patients and 98 healthy controls were collected. And it was found that serum miR-19a-3p in asymptomatic CAS patients was generally elevated (P < .05). Increased miR-19a-3p in asymptomatic CAS was associated with severe CAS (odds ratio  = 3.920, 95% confidence interval [CI] = 1.482-10.372, P < .01). The area under the receiver operating characteristic (ROC) curve (AUC) was 0.905, indicating that the level of miR-19a-3p was statistically significant for the diagnosis of asymptomatic CAS. Furthermore, the level of serum miR-19a-3p (hazard ratio [HR] = 8.507, 95% confidence interval [CI] = 2.239-32.328, P = .002) and degree of artery stenosis (HR = 3.695, 95% CI = 1.127-12.109, P = .031) were independent predictors of occurrence of CIE. Moreover, patients with elevated miR-19a-3p levels were more likely to experience CIE than patients with low levels. Upregulated miR-19a-3p can be used as a diagnostic biomarker for asymptomatic CAS patients and as an independent predictor of CIE.