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Boivin-Proulx LA, Marquis-Gravel G, Rousseau-Saine N, Harel F, Jolicoeur EM, Pelletier-Galarneau M. Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta-analysis. Eur J Clin Invest 2024; 54:e14178. [PMID: 38348627 DOI: 10.1111/eci.14178] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Given the limited access to invasive vasospastic reactivity testing in Western Countries, there is a need to further develop alternative non-invasive diagnostic methods for vasospastic angina (VSA). Hyperventilation testing (HVT) is defined as a class IIa recommendation to diagnose VSA by the Japanese Society of Cardiology. METHODS In this systematic review and meta-analysis reported according to the PRISMA statement, we review the mechanisms, methods, modalities and diagnostic accuracy of non-invasive HVT for the diagnostic of VSA. RESULTS A total of 106 articles published between 1980 and 2022 about VSA and HVT were included in the systematic review, among which 16 were included in the meta-analysis for diagnostic accuracy. Twelve electrocardiogram-HVT studies including 804 patients showed a pooled sensitivity of 54% (95% confidence intervals [CI]; 30%-76%) and a pooled specificity of 99% (95% CI; 88%-100%). Four transthoracic echocardiography-HVT studies including 197 patients revealed a pooled sensitivity of 90% (95% CI; 82%-94%) and a pooled specificity of 98% (95% CI; 86%-100%). Six myocardial perfusion imaging-HVT studies including 112 patients yielded a pooled sensitivity of 95% (95% CI; 63%-100%) and a pooled specificity of 78% (95% CI; 19%-98%). Non-invasive HVT resulted in a low rate of adverse events, ventricular arrhythmias being the most frequently reported, and were resolved with the administration of nitroglycerin. CONCLUSIONS Non-invasive HVT offers a safe alternative with high diagnostic accuracy to diagnose VSA in patients with otherwise undiagnosed causes of chest pain.
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Affiliation(s)
| | | | | | - François Harel
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - E Marc Jolicoeur
- CHUM Research Center and Cardiovascular Center, Montreal, Quebec, Canada
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2
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Lanza GA, Shimokawa H. Management of Coronary Artery Spasm. Eur Cardiol 2023; 18:e38. [PMID: 37456765 PMCID: PMC10345953 DOI: 10.15420/ecr.2022.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/14/2022] [Indexed: 07/18/2023] Open
Abstract
Calcium channel blockers (CCBs) are the first-line treatment for coronary artery spasm (CAS). When CAS-related angina symptoms are not well controlled by CCB therapy, long-acting nitrates or (where available) nicorandil can be added as second-line medications. In the case of CAS refractory to standard treatments, several other alternative drugs and interventions have been proposed, including the Rho-kinase inhibitor fasudil, anti-adrenergic drugs, neural therapies and percutaneous coronary interventions. In patients with syncope or cardiac arrest caused by CAS-related tachyarrhythmias, or even bradyarrhythmias, implantation of an ICD or pacemaker, respectively, should be considered according to the risk of recurrence and efficacy of vasodilator therapy.
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Affiliation(s)
- Gaetano Antonio Lanza
- Fondazione Policlinico A Gemelli IRCCS, Department of Cardiovascular Medicine, Università Cattolica del Sacro Cuore Rome, Italy
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3
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Sulej L, Momot K, Zarębiński M, Wojciechowska M. Reperfusion arrhythmias – underestimated cause of sudden cardiac death? Med Hypotheses 2023. [DOI: 10.1016/j.mehy.2023.111060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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4
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Yang HM, Lee JE, Kim JY, You J, Kim J, Lee HS, Yoo HM, Kong MG, Han JK, Cho HJ, Park KW, Kang HJ, Koo BK, Park YB, Kim HS. Identification of cell-biologic mechanisms of coronary artery spasm and its ex vivo diagnosis using peripheral blood-derived iPSCs. Biomater Res 2023; 27:16. [PMID: 36803875 PMCID: PMC9938986 DOI: 10.1186/s40824-023-00345-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/25/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Although vasospastic angina (VSA) is known to be caused by coronary artery spasm, no study has fully elucidated the exact underlying mechanism. Moreover, in order to confirm VSA, patients should undergo invasive coronary angiography with spasm provocation test. Herein, we investigated the pathophysiology of VSA using peripheral blood-derived induced pluripotent stem cells (iPSCs) and developed an ex vivo diagnostic method for VSA. METHODS AND RESULTS With 10 mL of peripheral blood from patients with VSA, we generated iPSCs and differentiated these iPSCs into target cells. As compared with vascular smooth muscle cells (VSMCs) differentiated from iPSCs of normal subjects with negative provocation test, VSA patient-specific iPSCs-derived VSMCs showed very strong contraction in response to stimulants. Moreover, VSA patient-specific VSMCs exhibited a significant increase in stimulation-induced intracellular calcium efflux (Changes in the relative fluorescence unit [ΔF/F]; Control group vs. VSA group, 2.89 ± 0.34 vs. 10.32 ± 0.51, p < 0.01), and exclusively induced a secondary or tertiary peak of calcium efflux, suggesting that those findings could be diagnostic cut-off values for VSA. The observed hyperreactivity of VSA patient-specific VSMCs were caused by the upregulation of sarco/endoplasmic reticulum Ca2+-ATPase 2a (SERCA2a) due to its enhanced small ubiquitin-related modifier (SUMO)ylation. This increased activity of SERCA2a was reversed by treatment with ginkgolic acid, an inhibitor of SUMOylated E1 molecules (pi/µg protein; VSA group vs. VSA + ginkgolic acid, 52.36 ± 0.71 vs. 31.93 ± 1.13, p < 0.01). CONCLUSIONS Our findings showed that abnormal calcium handling in sarco/endoplasmic reticulum could be induced by the enhanced SERCA2a activity in patients with VSA, leading to spasm. Such novel mechanisms of coronary artery spasm could be useful for drug development and diagnosis of VSA.
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Affiliation(s)
- Han-Mo Yang
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Joo-Eun Lee
- National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Ju-Young Kim
- National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Jihye You
- National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Joonoh Kim
- National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hak Seung Lee
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hee Min Yoo
- grid.410883.60000 0001 2301 0664Biometrology Group, Korea Research Institute of Standards and Science (KRISS), Daejeon, Korea
| | - Min Gyu Kong
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,grid.412678.e0000 0004 0634 1623Department of Internal Medicine, Soon Chun Hyang University Hospital, Bucheon, Korea
| | - Jung-Kyu Han
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jai Cho
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Kyung Woo Park
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jae Kang
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Bon-Kwon Koo
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Young-Bae Park
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080 Korea ,National Research Laboratory for Stem Cell Niche, Seoul, Korea ,grid.412484.f0000 0001 0302 820XInnovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daekak-Ro, Chongno-Gu, Seoul, 03080, Korea. .,National Research Laboratory for Stem Cell Niche, Seoul, Korea. .,Innovative Research Institute for Cell Therapy, Seoul National University Hospital, Seoul, Korea. .,Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, 03080, Korea.
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5
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Thomsen AF, Jøns C, Jabbari R, Jacobsen MR, Stampe NK, Butt JH, Olsen NT, Kelbæk H, Torp-Pedersen C, Fosbøl EL, Pedersen F, Køber L, Engstrøm T, Jacobsen PK. Long-term risk of new-onset arrhythmia in ST-segment elevation myocardial infarction according to revascularization status. Europace 2022; 25:931-939. [PMID: 36520640 PMCID: PMC10062371 DOI: 10.1093/europace/euac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Abstract
Aims
Emerging data show that complete revascularization (CR) reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). However, the influence of revascularization status on development of arrhythmia in the long-term post-STEMI phase is poorly described. We hypothesized that incomplete revascularization (ICR) compared with CR in STEMI is associated with an increased long-term risk of new-onset arrhythmia.
Methods and results
Patients with STEMI treated with primary percutaneous coronary intervention (PPCI) at Copenhagen University Hospital, Rigshospitalet, Denmark, with CR or ICR were identified via the Eastern Danish Heart registry from 2009 to 2016. Using unique Danish administrative registries, the outcomes were assessed. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter (AF), sinoatrial block, advanced second- or third-degree atrioventricular block, ventricular tachycardia/fibrillation (VT), or cardiac arrest (CA), with presentation >7 days post-PPCI. Secondary outcomes were the components of the primary outcome and all-cause mortality. A total of 5103 patients (median age: 62.0 years; 76% men) were included, of whom 4009 (79%) and 1094 (21%) patients underwent CR and ICR, respectively. Compared with CR, ICR was associated with a higher risk of new-onset arrhythmia [hazard ratio (HR), 1.33; 95% confidence interval (CI), 1.07–1.66; P = 0.01], AF (HR, 1.29; 95% CI, 1.00–1.66; P = 0.05), a combined outcome of VT and CA (HR, 1.77; 95% CI, 1.10–2.84; P = 0.02) and all-cause mortality (HR, 1.27; 95% CI, 1.05–1.53; P = 0.01). All HRs adjusted.
Conclusion
Among patients with STEMI, ICR was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with CR.
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Affiliation(s)
- Anna F Thomsen
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Christian Jøns
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Reza Jabbari
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Mia R Jacobsen
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Gentofte University Hospital , Gentofte Hospitalsvej 1, 2900 Hellerup , Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital , Sygehusvej 10, 4000 Roskilde , Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand University Hospital , Dyrehavevej 29, 3400 Hilleroed , Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Frants Pedersen
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, Rigshospitalet University Hospital , Blegdamsvej 9, 2100 Copenhagen , Denmark
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6
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Tateishi K, Kondo Y, Saito Y, Kitahara H, Fukushima K, Takahashi H, Yamashita D, Ohashi K, Suzuki K, Hashimoto O, Sakai Y, Kobayashi Y. Implantable cardioverter-defibrillator therapy after resuscitation from cardiac arrest in vasospastic angina: A retrospective study. PLoS One 2022; 17:e0277034. [PMID: 36315563 PMCID: PMC9621437 DOI: 10.1371/journal.pone.0277034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with vasospastic angina (VSA) who are resuscitated from sudden cardiac arrest (SCA) are at a high risk of recurrent lethal arrhythmia and cardiovascular events. However, the benefit of the implantable cardioverter-defibrillator (ICD) therapy in this population has not been fully elucidated. The present study aimed to analyze the prognostic impact of ICD therapy on patients with VSA and SCA. A total of 280 patients who were resuscitated from SCA and received an ICD for secondary prophylaxis were included in the present multicenter registry. The patients were divided into two groups on the basis of the presence of VSA. The primary endpoint was a composite of all-cause death and appropriate ICD therapy (appropriate anti-tachycardia pacing and shock) for recurrent ventricular arrhythmias. Of 280 patients, 51 (18%) had VSA. Among those without VSA, ischemic cardiomyopathy was the main cause of SCA (38%), followed by non-ischemic cardiomyopathies (18%) and Brugada syndrome (7%). Twenty-three (8%) patients were dead and 72 (26%) received appropriate ICD therapy during a median follow-up period of 3.8 years. There was no significant difference in the incidence of the primary endpoint between patients with and without VSA (24% vs. 33%, p = 0.19). In a cohort of patients who received an ICD for secondary prophylaxis, long-term clinical outcomes were not different between those with VSA and those with other cardiac diseases after SCA, suggesting ICD therapy may be considered in patients with VSA and those with other etiologies who were resuscitated from SCA.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
- * E-mail:
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Kenichi Fukushima
- Department of Cardiovascular Medicine, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Hidehisa Takahashi
- Department of Cardiovascular Medicine, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Daichi Yamashita
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Koichi Ohashi
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Ko Suzuki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Osamu Hashimoto
- Department of Cardiovascular Medicine, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Yoshiaki Sakai
- Department of Cardiovascular Medicine, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
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7
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Chuapakdee O, Layangkool T, Theerasuwipakorn N. Pyridostigmine-induced coronary artery spasm in early-onset myasthenia gravis: a case presentation and review of the literature. BMJ Case Rep 2022; 15:e249819. [PMID: 36104035 PMCID: PMC9476139 DOI: 10.1136/bcr-2022-249819] [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] [Indexed: 11/03/2022] Open
Abstract
We present a case of pyridostigmine-induced coronary artery spasm in a woman with early-onset myasthenia gravis (MG) who suffered from acute chest discomfort a few days after pyridostigmine dose up-titration. Twelve-lead ECG demonstrated ST-segment elevation in inferior limb leads together with sinus arrest. Sublingual nitrate was immediately given, which rapidly relieved her symptoms concomitantly with the resolution of abnormal ECG findings. Coronary angiography showed normal coronary arteries reflecting the transient nature of the disease. A small dose of pyridostigmine was rechallenged under close monitoring in the coronary care unit and reproduced her chest discomfort. After the substitution of pyridostigmine with immunosuppressive agents and prescription of long-acting nitrate, she had no recurrence of chest discomfort, as well as well-controlled MG symptoms.
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Affiliation(s)
- Oranuch Chuapakdee
- Division of Neurology, Department of Medicine, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand
| | - Tanit Layangkool
- Division of Cardiology, Department of Medicine, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand
| | - Nonthikorn Theerasuwipakorn
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Centre, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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8
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Shinohara T, Yonezu K, Hirota K, Kondo H, Fukui A, Akioka H, Teshima Y, Yufu K, Nakagawa M, Takahashi N. Fragmented QRS as a risk marker for the occurrence of ventricular fibrillation in patients with variant angina. Ann Noninvasive Electrocardiol 2022; 27:e12937. [PMID: 35170178 PMCID: PMC9107091 DOI: 10.1111/anec.12937] [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: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Variant angina (VA) is caused by reversible coronary artery spasm, which is characterized by chest pain with ST-segment elevations on standard 12-lead electrocardiogram (ECG) at rest. Ventricular fibrillation (VF) is often caused by VA attack, but the risk stratification is not well understood. The purpose of this study was to evaluate the impact of fragmented QRS (fQRS) on VF occurrence in VA patients. METHODS Ninety-four patients who showed ST elevation on 12-lead ECGs with total or nearly total occlusion in response to coronary spasm provocation test were enrolled. Among them, 16 patients had documented VF before hospital admission (n = 12) or experienced VF during provocation test (n = 4) (VF occurrence group). The fQRS was defined as the presence of spikes within the QRS complex of two or more consecutive leads. RESULTS The prevalence of fQRS was more often observed in the VF occurrence group than in the non-VF occurrence group (63% [10/16] vs. 27% [21/78], p = 0.009). Univariate analyses revealed that age, history of syncope, QTc, and the presence of fQRS were associated with VF occurrence (p = 0.004, 0.005, 0.029, and 0.008, respectively). Furthermore, upon multivariate analyses using those risk factors, age, QTc, and fQRS predicted VF occurrence independently (p = 0.007, 0.041, and 0.014, respectively). CONCLUSIONS The present study demonstrated that fQRS in VA patients is a risk factor for VF. The fQRS may be a useful factor for the risk stratification of VF occurrence in VA patients.
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Affiliation(s)
- Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan
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9
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Pathology of sudden death, cardiac arrhythmias, and conduction system. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Capsaicin and TRPV1 Channels in the Cardiovascular System: The Role of Inflammation. Cells 2021; 11:cells11010018. [PMID: 35011580 PMCID: PMC8750852 DOI: 10.3390/cells11010018] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/24/2022] Open
Abstract
Capsaicin is a potent agonist of the Transient Receptor Potential Vanilloid type 1 (TRPV1) channel and is a common component found in the fruits of the genus Capsicum plants, which have been known to humanity and consumed in food for approximately 7000-9000 years. The fruits of Capsicum plants, such as chili pepper, have been long recognized for their high nutritional value. Additionally, capsaicin itself has been proposed to exhibit vasodilatory, antimicrobial, anti-cancer, and antinociceptive properties. However, a growing body of evidence reveals a vasoconstrictory potential of capsaicin acting via the vascular TRPV1 channel and suggests that unnecessary high consumption of capsaicin may cause severe consequences, including vasospasm and myocardial infarction in people with underlying inflammatory conditions. This review focuses on vascular TRPV1 channels that are endogenously expressed in both vascular smooth muscle and endothelial cells and emphasizes the role of inflammation in sensitizing the TRPV1 channel to capsaicin activation. Tilting the balance between the beneficial vasodilatory action of capsaicin and its unwanted vasoconstrictive effects may precipitate adverse outcomes such as vasospasm and myocardial infarction, especially in the presence of proinflammatory mediators.
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11
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Takahashi J, Suda A, Nishimiya K, Godo S, Yasuda S, Shimokawa H. Pathophysiology and Diagnosis of Coronary Functional Abnormalities. Eur Cardiol 2021; 16:e30. [PMID: 34603510 PMCID: PMC8478147 DOI: 10.15420/ecr.2021.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/07/2021] [Indexed: 01/17/2023] Open
Abstract
Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary atherosclerotic stenosis. This clinical condition has recently been described as ischaemia with non-obstructive coronary arteries (INOCA). Coronary functional abnormalities are central to the pathogenesis of INOCA, including epicardial coronary spasm and coronary microvascular dysfunction composed of a variable combination of increased vasoconstrictive reactivity and/or reduced vasodilator function. During the last decade - in INOCA patients in particular - evidence for the prognostic impact of coronary functional abnormalities has accumulated and various non-invasive and invasive diagnostic techniques have enabled the evaluation of coronary vasomotor function in a comprehensive manner. In this review, the authors briefly summarise the recent advances in the understanding of pathophysiology and diagnosis of epicardial coronary artery spasm and coronary microvascular dysfunction.
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Affiliation(s)
- Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Akira Suda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan
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12
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Kim HL, Jo SH. Current Evidence on Long-Term Prognostic Factors in Vasospastic Angina. J Clin Med 2021; 10:jcm10184270. [PMID: 34575381 PMCID: PMC8469875 DOI: 10.3390/jcm10184270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/20/2023] Open
Abstract
Vasospastic angina (VSA) is characterized by a reversible spasm of the coronary arteries and is more prevalent in Asians. Vasodilators, such as calcium channel blockers, are effective in relieving coronary spasms and preventing clinical events. Therefore, the prognosis of VSA is generally known to be better than for significant organic stenosis caused by atherosclerosis. However, coronary vasospasm is sometimes associated with fatal complications such as sudden death, ventricular arrhythmia, and myocardial infarction. Thus, it is very important to identify and actively treat high-risk patients to prevent VSA complications. Here, we will review clinical factors associated with long-term prognosis in patients with VSA.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, National University College of Medicine, Seoul 07061, Korea;
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
- Correspondence: or
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Myerburg RJ. Non-Atherosclerotic causes of Myocardial Ischemia: With emphasis on spontaneous dissection of coronary arteries. Trends Cardiovasc Med 2021; 32:101-102. [PMID: 33607286 DOI: 10.1016/j.tcm.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J Myerburg
- Division of Cardiology, Professor of Medicine and Physiology, American Heart Association Chair in Cardiovascular Research, University of Miami Miller School of Medicine, Miami, Florida.
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Kim HL. A new perspective on calcium channel blockers in vasospastic angina. Korean J Intern Med 2021; 36:63-64. [PMID: 33472285 PMCID: PMC7820658 DOI: 10.3904/kjim.2020.628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government- Seoul National University Boramae Medical Center, Seoul, Korea
- Correspondence to Hack-Lyoung Kim, M.D. Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-3235 Fax: +82-2-831-2826 E-mail:
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Lechner A, Alderson T, Gautam S, Flaker G. Ventricular fibrillation due to coronary spasm after pepper spray. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:548-551. [PMID: 33368435 DOI: 10.1111/pace.14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/13/2020] [Indexed: 12/29/2022]
Abstract
Pepper spray is used as a crowd control agent and for self-defense. It has been thought to be safe; however, 27 persons have died in police custody after exposure to pepper spray. We report on a 21-year-old man, with no underlying heart disease and a normal ECG and echocardiogram in the past, who was pepper sprayed and developed ventricular fibrillation. An admission ECG showed marked ST segment elevation but subsequent coronary arteriography was normal. We hypothesize that pepper spray triggered coronary spasm, resulting in ventricular fibrillation. This report adds to a body of information that pepper spray is dangerous.
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Affiliation(s)
- Adam Lechner
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Tyler Alderson
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Greg Flaker
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
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Kim HL, Jo SH, Kim HJ, Lee MH, Seo WW, Baek SH. Sex differences in clinical characteristics and long-term outcomes in patients with vasospastic angina: results from the VA-Korea registry, a prospective multi-center cohort. Biol Sex Differ 2020; 11:66. [PMID: 33228754 PMCID: PMC7684896 DOI: 10.1186/s13293-020-00341-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background Sex differences in clinical characteristics and prognosis of vasospastic angina (VA) have not been well elucidated. This study was performed to investigate sex-specific characteristics and predictors for long-term clinical outcomes in patients with VA. Methods We analyzed 1838 patients (55 years and 62% male) who were diagnosed with definite (n = 680) or intermediate (n = 1212) VA in ergonovine provocation test from a nation-wide VA registry. The primary study end-point was composite events including cardiac death, acute coronary syndrome, ventricular tachycardia or fibrillation, and atrioventricular block during clinical follow-up. Results Male patients were younger, and there were more smokers and alcohol drinkers in male patients than in female patients. During the median follow-up period of 760 days (interquartile range, 336–1105 days), there were 73 cases (3.97%) of composite events. There was no sex difference in the occurrence of composite events (log-rank p = 0.649). Concomitant significant (≥ 50%) organic coronary stenosis was associated with worse clinical outcomes in both male (hazard ration [HR], 1.97; 95% confidence interval [CI], 1.01–3.85; p = 0.047) and female (HR, 3.26; 95% CI, 1.07–9.89; p = 0.037) patients. Obesity (body mass index ≥ 25 kg/m2) was associated with better prognosis in female VA patients (HR, 0.22; 95% CI, 0.07–0.68; p = 0.008). Even when only patients with definite diagnosis of VA were considered, there was no significant sex difference in clinical outcomes (log-rank p = 0.876). Conclusions In VA patients, there were several different clinical characteristics according to sex; however, long-term clinical outcome was similar between sexes. Significant organic coronary stenosis in both sexes and low body mass index (< 25 kg/m2) in females were associated with worse prognosis in VA patients.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
| | - Hyun-Jin Kim
- Department of Cardiology in Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Min-Ho Lee
- Department of Cardiovascular Medicine, Soonchunhyang Seoul Hospital, Seoul, Korea
| | - Won-Woo Seo
- Department of Cardiovascular Medicine, Hallym University Kangdong Hospital, Seoul, Korea
| | - Sang Hong Baek
- Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Alkharaza A, Al-Harbi M, El-Sokkari I, Doucette S, MacIntyre C, Gray C, Abdelwahab A, Sapp JL, Gardner M, Parkash R. The effect of revascularization on mortality and risk of ventricular arrhythmia in patients with ischemic cardiomyopathy. BMC Cardiovasc Disord 2020; 20:455. [PMID: 33087069 PMCID: PMC7576697 DOI: 10.1186/s12872-020-01726-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is clear evidence that patients with prior myocardial infarction and a reduced ejection fraction benefit from implantation of a cardioverter-defibrillator (ICD). It is unclear whether this benefit is altered by whether or not revascularization is performed prior to ICD implantation. Methods This was a retrospective cohort study following patients who underwent ICD implantation from 2002 to 2014. Patients with ischemic cardiomyopathy and either primary or secondary prevention ICDs were selected for inclusion. Using the electronic medical record, cardiac catheterization data, revascularization status (percutaneous coronary intervention or coronary bypass surgery) were recorded. The outcomes were mortality and ventricular arrhythmia. Results There were 606 patients included in the analysis. The mean age was 66.3 ± 10.1 years, 11.9% were women, and the mean LVEF was 30.5 ± 12.0, 58.9% had a primary indication for ICD, 82.0% of the cohort had undergone coronary catheterization prior to ICD implantation. In the overall cohort, there were fewer mortality and ventricular arrhythmia events in patients who had undergone prior revascularization. In patients who had an ICD for secondary prevention, revascularization was associated with a decrease in mortality (HR 0.46, 95% CI (0.24, 0.85) p = 0.015), and a trend towards fewer ventricular arrhythmia (HR 0.62, 95% CI (0.38, 1.00) p = 0.051). There was no association between death or ventricular arrhythmia with revascularization in patients with primary prevention ICDs. Conclusion Revascularization may be beneficial in preventing recurrent ventricular arrhythmia, and should be considered as adjunctive therapy to ICD implantation to improve cardiovascular outcomes.
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Affiliation(s)
- Ahmad Alkharaza
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Mousa Al-Harbi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ihab El-Sokkari
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Christopher Gray
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Amir Abdelwahab
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada.
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Roy R, Aldiwani H, Darouian N, Sharma S, Torbati T, Wei J, Nelson MD, Shufelt C, Minissian MB, Li L, Merz CNB, Mehta PK. Ambulatory and silent myocardial ischemia in women with coronary microvascular dysfunction: Results from the Cardiac Autonomic Nervous System study (CANS). Int J Cardiol 2020; 316:1-6. [PMID: 32320779 PMCID: PMC8312219 DOI: 10.1016/j.ijcard.2020.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/11/2020] [Accepted: 04/09/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Up to two-thirds of patients with obstructive coronary artery disease (CAD) have silent ischemia (SI), which predicts an adverse prognosis and can be a treatment target in obstructive CAD. Over 50% of women with ischemia and no obstructive CAD have coronary microvascular dysfunction (CMD), which is associated with adverse cardiovascular outcomes. We aimed to investigate the prevalence of SI in CMD in order to consider it as a potential treatment target. METHODS 36 women with CMD by coronary reactivity testing and 16 age matched reference subjects underwent 24-h 12-lead ambulatory ECG monitoring (Mortara Instruments) after anti-ischemia medication withdrawal. Ambulatory ECG recordings were reviewed by two-physician consensus masked to subject status for SI measured by evidence of ≥1 minute horizontal or downsloping ST segment depression ≥1.0 mm, measured 80 ms from the J point. RESULTS Demographics, resting heart rate, and systolic blood pressure were similar between CMD and reference subjects. Thirty-nine percent of CMD women had a total of 26 SI episodes vs. 0 episodes in the reference group (p = 0.002). Among these women 13/14 (93%) had SI, and few episodes (3/26, 12%) were symptomatic. Mean HR at the onset of SI was 96 ± 13 bpm and increased to 117 ± 16 bpm during the ischemic episodes. 87% reported symptoms that were not associated with ST depressions. CONCLUSIONS Ambulatory ischemia is prevalent in women with CMD, with a majority being SI, while most reported symptoms were not accompanied by ambulatory ischemia. Clinical trials evaluating anti-ischemic medications should be considered in the CMD population.
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Affiliation(s)
- Rajasree Roy
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Haider Aldiwani
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, LA, CA, United States of America
| | - Navid Darouian
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, LA, CA, United States of America
| | - Shilpa Sharma
- Internal Medicine Residency Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - Tina Torbati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, LA, CA, United States of America
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, LA, CA, United States of America
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington, United States of America
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, LA, CA, United States of America
| | - Margo B Minissian
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, LA, CA, United States of America
| | - Lian Li
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States of America
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, LA, CA, United States of America
| | - Puja K Mehta
- Emory Women's Heart Center and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States of America.
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Vasospastic angina and overlapping cardiac disorders in patients resuscitated from cardiac arrest. Heart Vessels 2020; 36:321-329. [PMID: 32990791 DOI: 10.1007/s00380-020-01705-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vasospastic angina (VSA) reportedly accounts for one form of sudden cardiac arrest (SCA). Intracoronary acetylcholine (ACh) testing is useful for diagnosing VSA although invasive provocation testing after SCA is a clinical challenge. In addition, even if the ACh test is positive, any causal relationship between VSA and SCA is often unclear because patients with VSA may have other underlying cardiac disorders. METHODS A total of 20 patients without overt structural heart disease who had been fully resuscitated from SCA were included. All patients underwent the ACh provocation test and scrutiny such as cardiac computed tomography or magnetic resonance imaging. Patients were followed up for all-cause death or recurrent SCA including appropriate implantable cardioverter defibrillator therapy. RESULTS An ACh provocation test was performed 20 ± 17 days after cardiac arrest. Fifteen out of 20 (75.0%) patients had a positive ACh test and 2 (10.0%) had adverse events such as ventricular tachycardia and transient cardiogenic shock during the test. In patients with a positive ACh test, 6 of 15 (40.0%) patients had other overlapping cardiac disorders such as long QT syndrome, Brugada syndrome, cardiac sarcoidosis, myocarditis, or cardiomyopathy. Long-term prognosis was not different regardless of a positive ACh test or the presence of other cardiac disorders overlapping with VSA. CONCLUSIONS Three-quarters of the patients who had been resuscitated from SCA had a positive ACh test. Further examinations revealed other overlapping cardiac disorders in addition to VSA in 40% of patients with a positive ACh test.
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Abstract
BACKGROUND There is no clear consensus on the potential efficacy and indications for sympathectomy to prevent recurrence of vasospasm in patients with refractory coronary artery spasm (CAS). OBJECTIVE To compare the clinical outcomes of sympathectomy with those of conventional treatment in patients with refractory CAS. PATIENTS AND METHODS Patients with refractory CAS were randomly assigned to sympathectomy group (n = 37) or conventional treatment group (n = 42). The primary end point was a composite of major adverse cardiac event (MACE) episodes (including cardiac death, nonfatal myocardial infarction, unstable angina, heart failure, and life-threatening arrhythmia), and the secondary end point was death from any cause within 24 months after randomization. RESULTS During the follow-up period of 24 months, the incidence of MACE in the sympathectomy and conventional treatment groups was 16.22 and 61.90%, respectively (P = 0.0001). All-cause death as the secondary end point occurred in zero and six (14.29%) patients, respectively (P = 0.0272). The Kaplan-Meier curve for MACE and all-cause death showed a significant between-group difference (log-rank test, P = 0.0013 and 0.0176, respectively). CONCLUSION Compared with conventional treatment, sympathectomy significantly reduced the composite end point of MACE episodes and death from any cause in patients with refractory CAS by effectively preventing recurrence of vasospasm.
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Sex-Based Considerations in the Evaluation of Chest Pain and Management of Obstructive Coronary Artery Disease. Curr Atheroscler Rep 2020; 22:39. [DOI: 10.1007/s11883-020-00855-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Questionnaire in patients with aborted sudden cardiac death due to coronary spasm in Japan. Heart Vessels 2020; 35:1640-1649. [PMID: 32533313 DOI: 10.1007/s00380-020-01644-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We investigated the medical or mechanical therapy, and the present knowledge of Japanese cardiologists about aborted sudden cardiac death (ASCD) due to coronary spasm. METHODS A questionnaire was developed regarding the number of cases of ASCD, implantable cardioverter-defibrillator (ICD), and medical therapy in ASCD patients due to coronary spasm. The questionnaire was sent to the Japanese general institutions at random in 204 cardiology hospitals. RESULTS The completed surveys were returned from 34 hospitals, giving a response rate of 16.7%. All SCD during the 5 years was observed in 5726 patients. SCD possibly due to coronary spasm was found in 808 patients (14.0%) and ASCD due to coronary spasm was observed in 169 patients (20.9%). In 169 patients with ASCD due to coronary spasm, one or two coronary vasodilators was administered in two-thirds of patients [113 patients (66.9%)], while more than 3 coronary vasodilators were found in 56 patients (33.1%). ICD was implanted in 117 patients with ASCD due to coronary spasm among these periods including 35 cases with subcutaneous ICD. Majority of cause of ASCD was ventricular fibrillation, whereas pulseless electrical activity was observed in 18 patients and complete atrioventricular block was recognized in 7 patients. Mean coronary vasodilator number in ASCD patients with ICD was significantly lower than that in those without ICD (2.1 ± 0.9 vs. 2.6 ± 1.0, p < 0.001). Although 16 institutions thought that the spasm provocation tests under the medications had some clinical usefulness of suppressing the next fatal arrhythmias, spasm provocation tests under the medication were performed in just 4 institutions. CONCLUSIONS In the real world, there was no fundamental strategy for patients with ASCD due to coronary spasm. Each institution has each strategy for these patients. Cardiologists should have the same strategy and the same knowledge about ASCD patients due to coronary spasm in the future.
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Lee DH, Lee BK, Kim YH, Park YS, Sim MS, Kim SJ, Oh SH, Lee DH, Kim YJ, Kim WY. Vasospasm-related Sudden Cardiac Death Has Outcomes Comparable with Coronary Stenosis in Out-of-Hospital Cardiac Arrest. J Korean Med Sci 2020; 35:e131. [PMID: 32419397 PMCID: PMC7234855 DOI: 10.3346/jkms.2020.35.e131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Characteristics of coronary vasospasm-related sudden cardiac death are not well understood. We aimed to compare the characteristics and clinical outcomes between coronary vasospasm and stenosis, in out-of-hospital cardiac arrest (OHCA) survivors, who underwent coronary angiogram (CAG). METHODS We conducted a multicenter retrospective observational registry-based study at 8 Korean tertiary care centers. Data of OHCA survivors undergoing CAG between 2010 and 2015 were extracted. Patients were divided into vasospasm and stenosis (stenosis > 50%) groups based on CAG findings. The primary and the secondary outcomes were survival and a good neurologic outcome at 30 days after OHCA. Patients in the vasospasm and stenosis groups were propensity score matched. RESULTS Of the 413 included patients, vasospasm and stenosis groups comprised 87 and 326 patients, respectively. There were 279 (66.7%) survivors and 206 (49.3%) patients with good neurologic outcomes. The vasospasm group had better clinical characteristics for outcome (younger age, less diabetes and hypertension, more prehospital restoration of spontaneous circulation, higher Glasgow Coma Scale, less ST segment elevation, and less requirement of circulatory support). The vasospasm group had better survival (75/87 vs. 204/326, P < 0.001) and good neurologic outcomes (62/87 vs. 144/326, P < 0.001). However, vasospasm was not independently associated with survival (odds ratio [OR], 0.980; 95% confidence interval [CI], 0.400-2.406) or neurologic outcomes (OR, 0.870; 95% CI, 0.359-2.108) after adjustment and vasospasm was not associated with survival and neurologic outcome in propensity score-matched cohorts. CONCLUSION Our analysis of propensity score-matched cohorts finds that vasospasm OHCA survivors have survival and neurologic outcomes comparable with those of stenotic OHCA survivors.
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Affiliation(s)
- Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University, College of Medicine, Seoul, Korea
| | - Youn Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Vasospastic angina is an uncommon cause of cardiac arrest. We describe a patient who presented with sudden cardiac arrest due to severe coronary vasospasm. Telemetry during the event revealed ventricular arrhythmias and asystole followed by spontaneous self-conversion back to normal sinus rhythm. The patient underwent implantable cardioverter-defibrillator therapy. (Level of Difficulty: Beginner.)
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Hwang YJ, Cho DH. Activation of AMPK/proteasome/MLCK degradation signaling axis by telmisartan inhibits VSMC contractility and vessel contraction. Biochem Biophys Res Commun 2020; 524:853-860. [DOI: 10.1016/j.bbrc.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
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Hung MY, Kounis NG, Lu MY, Hu P. Myocardial Ischemic Syndromes, Heart Failure Syndromes, Electrocardiographic Abnormalities, Arrhythmic Syndromes and Angiographic Diagnosis of Coronary Artery Spasm: Literature Review. Int J Med Sci 2020; 17:1071-1082. [PMID: 32410837 PMCID: PMC7211159 DOI: 10.7150/ijms.43472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/23/2020] [Indexed: 01/06/2023] Open
Abstract
In coronary artery spasm (CAS), an excess coronary vasoconstriction causing total or subtotal vessel occlusion could lead to syncope, heart failure syndromes, arrhythmic syndromes, and myocardial ischemic syndromes including asymptomatic myocardial ischemia, stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Although the clinical significance of CAS has been underrated because of the frequent absence of symptoms, affected patients appear to be at higher risk of syncope, serious arrhythmias, and sudden death than those with classic Heberden's angina pectoris. Therefore, a prompt diagnosis has important therapeutic implications, and is needed to avoid CAS-related complications. While a definitive diagnosis is based mainly on coronary angiography and provocative testing, clinical features may help guide decision-making. We perform a literature review to assess the past and current state of knowledge regarding the clinical features, electrocardiographic abnormalities and angiographic diagnosis of CAS, while a discussion of mechanisms is beyond the scope of this review.
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Affiliation(s)
- Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Rion, Patras, Achaia, Greece
| | - Meng-Ying Lu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Patrick Hu
- University of California, Riverside, Riverside, California, USA.,Department of Cardiology, Riverside Medical Clinic, Riverside, California, USA
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A Memorable Telemetry Diagnosis of Transient “Tombstone” ST-Segment Elevations Instigating Ventricular Fibrillation. JACC Clin Electrophysiol 2019; 5:1475-1476. [DOI: 10.1016/j.jacep.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 11/23/2022]
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Comparison of Two-Year Outcomes of Acute Myocardial Infarction Caused by Coronary Artery Spasm Versus that Caused by Coronary Atherosclerosis. Am J Cardiol 2019; 124:1493-1500. [PMID: 31547996 DOI: 10.1016/j.amjcard.2019.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022]
Abstract
The study compared the 2-year outcomes of patients diagnosed with acute myocardial infarction (AMI) triggered by coronary artery atherosclerosis and AMI caused by coronary artery spasm. A total of 36,797 patients in the Korea AMI Registry were grouped into 2 categories-(1) AMI due to coronary artery spasm without stenotic lesion (CAS-AMI, n = 484); and (2) AMI induced by coronary artery atherosclerosis (CAA-AMI, n = 36,313). The major clinical outcomes of the 2 groups were compared over a 2-year clinical follow-up period. Major adverse cardiac events (MACE) were defined as the composite of total death, nonfatal myocardial infarction, and repeat revascularization. The incidence of MACE (7.1% vs 11.1%; p = 0.007) and repeat revascularization (0.4% vs 4.2%; p <0.001) in the CAS-AMI group were significantly lower than in the CAA-AMI group at 2 years. However, the incidence of total death and nonfatal myocardial infarction was similar in both the groups. Aborted cardiac arrest was strongly associated with 2-year mortality in the CAS-AMI group (hazard ratios 13.5, 95% confidence interval 5.34 to 34.15, p <0.001) The incidence of MACE in CAS-AMI patients was significantly lower than in the CAA-AMI group of patients up to 2 years due to the relatively lower rate of repeat revascularization in CAS-AMI patients. However, the incidence of total death or nonfatal myocardial infarction in CAS-AMI patients was not different from that of patients with CAA-AMI.
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Cristina-Oliveira M, Meireles K, Spranger MD, O'Leary DS, Roschel H, Peçanha T. Clinical safety of blood flow-restricted training? A comprehensive review of altered muscle metaboreflex in cardiovascular disease during ischemic exercise. Am J Physiol Heart Circ Physiol 2019; 318:H90-H109. [PMID: 31702969 DOI: 10.1152/ajpheart.00468.2019] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Blood flow restriction training (BFRT) is an increasingly widespread method of exercise that involves imposed restriction of blood flow to the exercising muscle. Blood flow restriction is achieved by inflating a pneumatic pressure cuff (or a tourniquet) positioned proximal to the exercising muscle before, and during, the bout of exercise (i.e., ischemic exercise). Low-intensity BFRT with resistance training promotes comparable increases in muscle mass and strength observed during high-intensity exercise without blood flow restriction. BFRT has expanded into the clinical research setting as a potential therapeutic approach to treat functionally impaired individuals, such as the elderly, and patients with orthopedic and cardiovascular disease/conditions. However, questions regarding the safety of BFRT must be fully examined and addressed before the implementation of this exercise methodology in the clinical setting. In this respect, there is a general concern that BFRT may generate abnormal reflex-mediated cardiovascular responses. Indeed, the muscle metaboreflex is an ischemia-induced, sympathoexcitatory pressor reflex originating in skeletal muscle, and the present review synthesizes evidence that BFRT may elicit abnormal cardiovascular responses resulting from increased metaboreflex activation. Importantly, abnormal cardiovascular responses are more clearly evidenced in populations with increased cardiovascular risk (e.g., elderly and individuals with cardiovascular disease). The evidence provided in the present review draws into question the cardiovascular safety of BFRT, which clearly needs to be further investigated in future studies. This information will be paramount for the consideration of BFRT exercise implementation in clinical populations.
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Affiliation(s)
- Michelle Cristina-Oliveira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Kamila Meireles
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Marty D Spranger
- Department of Physiology, Michigan State University, East Lansing, Michigan
| | - Donal S O'Leary
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
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Srinivasan SR, Shakkottai VG. Moving Towards Therapy in SCA1: Insights from Molecular Mechanisms, Identification of Novel Targets, and Planning for Human Trials. Neurotherapeutics 2019; 16:999-1008. [PMID: 31338702 PMCID: PMC6985354 DOI: 10.1007/s13311-019-00763-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The spinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders inherited in an autosomal dominant fashion. The SCAs result in progressive gait imbalance, incoordination of the limbs, speech changes, and oculomotor dysfunction, among other symptoms. Over the past few decades, significant strides have been made in understanding the pathogenic mechanisms underlying these diseases. Although multiple efforts using a combination of genetics and pharmacology with small molecules have been made towards developing new therapeutics, no FDA approved treatment currently exists. In this review, we focus on SCA1, a common SCA subtype, in which some of the greatest advances have been made in understanding disease biology, and consequently potential therapeutic targets. Understanding of the underlying basic biology and targets of therapy in SCA1 is likely to give insight into treatment strategies in other SCAs. The diversity of the biology in the SCAs, and insight from SCA1 suggests, however, that both shared treatment strategies and specific approaches tailored to treat distinct genetic causes of SCA are likely needed for this group of devastating neurological disorders.
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Affiliation(s)
| | - Vikram G Shakkottai
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
- Department of Molecular and Integrative Physiology, University of Michigan, 4009 BSRB, 109 Zina Pitcher Place, Ann Arbor, Michigan, 48109, USA.
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Lin Y, Qin H, Chen R, Liu Q, Liu H, Dong S. A comprehensive clinical diagnostic score system for prediction of coronary artery spasm in patients with acute chest pain. IJC HEART & VASCULATURE 2019; 22:205-209. [PMID: 30963096 PMCID: PMC6437281 DOI: 10.1016/j.ijcha.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/21/2019] [Accepted: 02/01/2019] [Indexed: 01/28/2023]
Abstract
Background Currently, there is no validated multivariate model to predict probability of coronary artery spasm (CAS) in patients with acute chest pain. Methods A total of 976 consecutive patients with acute chest pain were enrolled. Patients were divided into two groups based on the presence of significant CAS. To adjust potential confounders, a multivariable analysis was performed and a clinical diagnostic score system for CAS was utilized for score derivation. Results Multivariable analysis model selected 6 predictors for CAS. The integer score was assigned to each predictors: angina at rest alone (10 points), positive of hyperventilation test (8 points), allergies (3 points), asthma, ST-segment elevation and myocardial bridge (2 points each). We showed that the clinical diagnostic score system had accuracy in predicting CAS, as measured by the area under the curve (AUC), which was 0.952–0.966. The cut-off baseline value for the clinical diagnostic score system was set to 11–12 points with specificity of 91.0–93.3% and sensitivity of 90.7–92.9%, respectively. Conclusion A clinical diagnostic score system was derived and validated as an accurate tool for estimating the pretest probability of CAS in patients with acute chest pain.
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Affiliation(s)
- Yaowang Lin
- Department of Cardiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020 Shenzhen, Guangdong, PR China
| | - Haiyan Qin
- Department of Neurology, Longgang District People's Hospital of Shenzhen, No. 53, Love road, Longgang District, 518020 Shenzhen, Guangdong, PR China
| | - Ruimian Chen
- Department of Cardiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020 Shenzhen, Guangdong, PR China
| | - Qiyun Liu
- Department of Cardiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020 Shenzhen, Guangdong, PR China
| | - Huadong Liu
- Department of Cardiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020 Shenzhen, Guangdong, PR China
| | - Shaohong Dong
- Department of Cardiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020 Shenzhen, Guangdong, PR China
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Rodríguez-Mañero M, Oloriz T, le Polain de Waroux JB, Burri H, Kreidieh B, de Asmundis C, Arias MA, Arbelo E, Díaz Fernández B, Fernández-Armenta J, Basterra N, Izquierdo MT, Díaz-Infante E, Ballesteros G, Carrillo López A, García-Bolao I, Benezet-Mazuecos J, Expósito-García V, Larraitz-Gaztañaga, Martínez-Sande JL, García-Seara J, González-Juanatey JR, Peinado R. Long-term prognosis of patients with life-threatening ventricular arrhythmias induced by coronary artery spasm. Europace 2019; 20:851-858. [PMID: 28387796 DOI: 10.1093/europace/eux052] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/10/2017] [Indexed: 12/13/2022] Open
Abstract
Aims Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. Methods and results A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17-117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Conclusion Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Teresa Oloriz
- Electrophysiology Unit, Cardiology Service, Hospital Miguel Servet Zaragoza, Zaragoza, Spain
| | | | - Haran Burri
- Electrophysiology Unit, Cardiology Service, University Hospital of Geneva, Geneva, Switzerland
| | - Bahij Kreidieh
- Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | | | - Miguel A Arias
- Electrophysiology Unit, Cardiology Service, Hospital Virgen de la Salud, Toledo, Spain
| | - Elena Arbelo
- Electrophysiology Unit, Cardiology Service, Hospital Clinic Barcelona, Barcelona, Spain
| | - Brais Díaz Fernández
- Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | | | - Nuria Basterra
- Electrophysiology Unit, Cardiology Service, Hospital Universitario La Fe, Valencia, Spain
| | - María Teresa Izquierdo
- Electrophysiology Unit, Cardiology Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ernesto Díaz-Infante
- Electrophysiology Unit, Cardiology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Gabriel Ballesteros
- Electrophysiology Unit, Cardiology Service, Clínica Universidad de Navarra, Pamplona. Navarra, Spain
| | - Andrés Carrillo López
- Coronary and Intensive Care Unit, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Ignacio García-Bolao
- Coronary and Intensive Care Unit, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Juan Benezet-Mazuecos
- Electrophysiology Unit, Cardiology Service, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Victor Expósito-García
- Electrophysiology Unit, Cardiology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Larraitz-Gaztañaga
- Electrophysiology Unit, Cardiology Service, Hospital Universitario de Basurto, Bilbao, Spain
| | - Jose Luis Martínez-Sande
- Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Javier García-Seara
- Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Jose Ramón González-Juanatey
- Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain
| | - Rafael Peinado
- Electrophysiology Unit, Cardiology Service, Hospital Universitario La Paz, Madrid, Spain
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Sudden coronary death in the young: Evidence of contractile phenotype of smooth muscle cells in the culprit atherosclerotic plaque. Int J Cardiol 2019; 264:1-6. [PMID: 29776555 DOI: 10.1016/j.ijcard.2018.02.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/12/2018] [Accepted: 02/23/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Culprit coronary atherosclerotic plaques (APs) from young sudden cardiac death (SCD) victims are mostly non-atheromatous, i.e., consisting of proliferative smooth muscle cells (SMCs). Coronary vasospasm has been advocated to explain plaque instability in the absence of thrombosis. Our aim was to characterize the SMC phenotype in the intima and media of coronary arteries from young SCD victims. METHODS AND RESULTS A total of 38 coronary artery segments were studied: (a) 18 APs from young (≤40 years old) SCD patients, (b) 9 APs from old (>40 years old) SCD patients, (c) 11 non-atherosclerotic coronary arteries from young patients (≤40 years old). Markers of differentiated SMCs such as α-smooth muscle actin (α-SMA), smooth muscle myosin heavy chains (SMMHCs), and heavy-caldesmon (h-CaD), were assessed in intima and media by immunohistochemistry and quantified morphometrically. In the intima, their expression was higher in non-atherosclerotic arteries (44.37 ± 3.03% for α-SMA, 14.21 ± 2.01% for SMMHCs, 8.90 ± 1.33% for h-CaD) and APs from young SCD victims (38.95 ± 2.29% for α-SMA, 11.92 ± 1.92% for SMMHCs, 8.93 ± 1.12% for h-CaD) compared with old patients (22.01 ± 3.56% for α-SMA, 6.39 ± 0.7% for SMMHCs, 3.00 ± 0.57% for h-CaD; all P statistically significant). The media of non-atherosclerotic arteries and APs from young SCD victims exhibited strong positivity for the differentiation markers unlike that of old patients. CONCLUSIONS SMCs of coronary APs as well as from the underlying media from young SCD victims exhibit strong contractile phenotype. In the setting of critical stenosis, both intima and media SMC contractility might contribute to transient coronary spasm leading to myocardial ischemia and SCD.
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Dalia AA, Essandoh M, Cronin B, Hussain N, Gerstein NS, Schulman P. A Narrative Review for Anesthesiologists of the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. J Cardiothorac Vasc Anesth 2019; 33:1722-1730. [PMID: 30685157 DOI: 10.1053/j.jvca.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Indexed: 11/11/2022]
Abstract
This is a review of the 2017 AHA/ACC/HRS Guidelines with guidance for intraoperative physicians. Ventricular arrhythmias occurring during the perioperative period have the potential for significant morbidity and mortality. Hence, an in-depth knowledge of VA mechanisms, prevention, and management is crucial for all clinicians caring for these at-risk patients in the perioperative period. Perioperative optimization of patients with a known or suspected VA should be tailored to the specific patient population and condition as outlined in this manuscript.
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Affiliation(s)
- Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, The Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Michael Essandoh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Brett Cronin
- Department of Anesthesiology, University of California, San Diego, CA
| | - Nasir Hussain
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, University of New Mexico, Albuquerque, NM
| | - Peter Schulman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR
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Benezet-Mazuecos J, Iglesias JA, Rubio JM, Sanchez-Borque P, Miracle A. Ineffective appropriate shocks in coronary artery spasm disease: when defibrillation is not enough. J Interv Card Electrophysiol 2019; 54:55-58. [DOI: 10.1007/s10840-018-0447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
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Iiya M, Yamawake N, Nishizaki M, Shimizu M, Fujii H, Suzuki M, Sakurada H, Hiraoka M. Ventricular Fibrillation Induced by Coronary Vasospasm in a Patient with Early Repolarization and Hyperthyroidism. Intern Med 2018; 57:3389-3392. [PMID: 30101915 PMCID: PMC6306529 DOI: 10.2169/internalmedicine.1104-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Vasospastic angina (VSA) has been recognized as a cause of ventricular fibrillation (VF) degenerating into sudden cardiac death. We experienced a case of VSA with hyperthyroidism in which VF was provoked with an augmented J-wave amplitude in the inferior leads. The patient underwent insertion of an implantable cardioverter-defibrillator for the secondary prevention of VF in addition to taking Ca-channel antagonists. He has shown no recurrence of fatal arrhythmia or anginal attack for a follow-up period of one year.
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Affiliation(s)
- Munehiro Iiya
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | | | | | - Masato Shimizu
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Hiroyuki Fujii
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital, Japan
| | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Japan
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Deyama J, Nakamura T, Saito Y, Obata JE, Fujioka D, Nakamura K, Watanabe K, Kugiyama K. Effect of coronary artery spasm on long-term outcomes in survivors of acute myocardial infarction. Int J Cardiol 2018; 257:7-11. [PMID: 29506741 DOI: 10.1016/j.ijcard.2017.08.002] [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] [Received: 07/03/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of coronary artery spasm (CAS) inducible by intracoronary injection of acetylcholine (ACh) is high in survivors of acute myocardial infarction (AMI). Although there is a potential risk of sudden cardiac death in patients with CAS, the prognostic value of CAS was not clear. Thus, this study examined the effect of CAS on long-term prognosis in survivors of AMI in a prospective manner. METHODS The study included a total of 437 patients with AMI who underwent a CAS provocation test using ACh. All patients were followed prospectively for 5years or until the occurrence of the primary composite endpoint that consisted of cardiac death and acute coronary syndrome (ACS). RESULTS CAS was induced in 195 (45%) of the study patients. During the follow-up period, 30 patients had a recurrent event (4 had cardiac death and 26 had ACS). Kaplan-Meier estimates in time-to-first-event analysis demonstrated a similar probability of the primary endpoint in patients with and without inducible CAS (p=0.13, log-rank test). The rate of each component of the composite endpoint was also comparable between the 2 patient groups. In Cox proportional hazards risk analysis, treatment with calcium channel blockers (CCBs) negatively predicted the primary endpoints in patients with inducible CAS (HR, 0.21; 95% CI, 0.08-0.55, p<0.01). CONCLUSIONS The presence of inducible CAS did not increase the incidence of the cardiac events in AMI survivors. Treatment with CCBs may improve outcomes in AMI survivors with inducible CAS. CLINICAL TRIAL REGISTRATION URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000021340, unique identifier: UMIN000018432.
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Affiliation(s)
- Juntaro Deyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Yukio Saito
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Jun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Daisuke Fujioka
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kazuto Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kazuhiro Watanabe
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e210-e271. [PMID: 29084733 DOI: 10.1161/cir.0000000000000548] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Kitano D, Takayama T, Sudo M, Kogo T, Kojima K, Akutsu N, Nishida T, Haruta H, Fukamachi D, Kawano T, Kanai T, Hiro T, Saito S, Hirayma A. Angioscopic differences of coronary intima between diffuse and focal coronary vasospasm: Comparison of optical coherence tomography findings. J Cardiol 2018; 72:200-207. [DOI: 10.1016/j.jjcc.2018.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 01/12/2023]
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 700] [Impact Index Per Article: 116.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Cho S, Kang TS. Multi-vessel intractable coronary spasm development in a patient with aborted sudden cardiac death: a case study with intravascular ultrasound findings. Yeungnam Univ J Med 2018; 35:121-126. [PMID: 31620582 PMCID: PMC6784666 DOI: 10.12701/yujm.2018.35.1.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/29/2018] [Accepted: 02/09/2018] [Indexed: 11/08/2022] Open
Abstract
Coronary spasm generally occurs in patients with minimal atherosclerotic plaque lesion, and it has a rather favorable prognosis. However, in some cases, coronary spasm may induce myocardial infarction and even sudden cardiac death (SCD). Here, we report a case in which multi-vessel intractable coronary vasospasm suddenly occurred in a diffuse atherosclerotic lesion after percutaneous coronary intervention (PCI) in a patient with aborted SCD. We identified the characteristics of the spasm portion in intravascular ultrasound (IVUS) images and conducted percutaneous cardiopulmonary bypass support-PCI with stenting as treatment. Intima and media thickening and a large attenuated plaque burden with rupture were identified in IVUS images at the obstructive spasm portion.
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Affiliation(s)
| | - Tae Soo Kang
- Corresponding Author: Tae Soo Kang, Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, 201, Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: +82-41-550-7690, Fax: +82-41-556-0524 E-mail:
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Sueda S, Kohno H. Optimal Medications and Appropriate Implantable Cardioverter-defibrillator Shocks in Aborted Sudden Cardiac Death Due to Coronary Spasm. Intern Med 2018; 57:1361-1369. [PMID: 29321418 PMCID: PMC5995710 DOI: 10.2169/internalmedicine.8796-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Life-threatening ventricular arrhythmias are recognized in patients with coronary spastic angina. Implantable cardioverter-defibrillators (ICDs) are effective in patients with structural heart disease and ventricular fibrillation. However, the optimal medication for patients with aborted sudden cardiac death (SCD) due to coronary artery spasm after the implantation of ICD remains controversial. Methods We investigated the medications and the numbers of appropriate ICD shocks in 137 patients with a history of aborted SCD due to coronary spasm. Results Appropriate ICD shocks were observed in 24.1% (33/137) of patients with aborted SCD due to coronary spasm during 41 months of follow-up. Only 15 (15.6%) of the 96 patients with ICDs received aggressive medical therapy, including two or three calcium-channel antagonists. The rate of appropriate ICD shocks was significantly higher in Western countries than in Asian countries (42.9% vs. 19.3%, p<0.01), whereas the medications did not differ between the two regions. Appropriate ICD shocks successfully resuscitated 33 patients. Three patients died due to second serious fatal arrhythmias. Conclusion Appropriate ICD shocks were recognized in a quarter of patients with aborted SCD due to coronary spasm and ICD implantation was effective for suppressing the next serious fatal arrhythmia in these patients. We should reconsider prescribing more medications after ICD implantation in patients with aborted SCD due to coronary artery spasm.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan
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45
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Baghdasaryan L. A 16-year-old boy with bronchial asthma and prinzmetal angina: case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty042. [PMID: 31020122 PMCID: PMC6177102 DOI: 10.1093/ehjcr/yty042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 11/15/2022]
Abstract
Introduction Prinzmetal’s angina is a very rare disease in children and adolescents. Adults’ studies suggest that vasospastic angina is more common in patients with bronchial asthma than in the general population. Case presentation A 16-year-old boy with a history of bronchial asthma was admitted to the hospital after successful resuscitation from asystole. On the day of admission, he had a severe left shoulder pain and developed cardiac arrest. He was complaining of left shoulder pain throughout the previous year. During his hospital stay, a second cardiac arrest took place with inferior ST elevation of the electrocardiography recorded after the second successful resuscitation. Diagnostic coronary angiography revealed multiple spasms throughout the coronary bed, which was completely resolved after intracoronary nitroglycerine administration. The patient was diagnosed Printzmetal’s vasospasic angina, and the symptoms disappeared gradually with up-titration of a calcium channel blocker and a nitrate. Discussion Previous studies have suggested that the pathogenesis of Prinzmetal’s vasospastic angina may be similar to that of bronchial asthma, as we see in the presentation of this young patient.
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Abstract
PURPOSE OF REVIEW Variant angina, which is characterized by recurrent chest pain and transient ECG changes along with angiographic evidence of coronary artery spasm, generally has a favorable prognosis. However, episodes of ischemia caused by vasospasm may lead to potentially life-threatening ventricular arrhythmias and cardiac arrest, even in patients with no history of prior cardiac disease. This review describes the epidemiology, pathogenesis, clinical spectrum, and management of variant angina, as well as outcomes in patients who present with aborted sudden cardiac death (ASCD). RECENT FINDINGS Contrary to prior opinions, evidence from recent observational studies indicate that patients with variant angina presenting with ASCD face a worse prognosis than those without this type of presentation. Predictors of ASCD include age, hypertension, hyperlipidemia, family history of sudden cardiac death, multi-vessel spasm, and left anterior descending artery spasm. Medical therapy alone with calcium channel blockers and nitrates may not be sufficiently protective in these patients and there is lack of concrete data on the optimal management strategy. Current guidelines recommend implantable cardiac defibrillator (ICD) therapy in patients who are survivors of cardiac arrest caused by ventricular fibrillation or unstable ventricular tachycardia after reversible causes are excluded, and should strongly be considered in these patients. Although medical therapy is absolutely imperative for patients with variant angina and a history of ASCD, ICD therapy in these patients is justified. Further large-scale studies are required to determine whether ICD therapy can improve survival in this high-risk group of patients.
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Affiliation(s)
- Amartya Kundu
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA.
| | - Aditya Vaze
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Partha Sardar
- Department of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ahmed Nagy
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Naomi F Botkin
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
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Kim YH, Her AY, Rha SW, Choi BG, Shim M, Choi SY, Byun JK, Li H, Kim W, Kang JH, Choi JY, Park EJ, Park SH, Lee S, Na JO, Choi CU, Lim HE, Kim EJ, Park CG, Seo HS, Oh DJ. Five-year major clinical outcomes according to severity of coronary artery spasm as assessed by intracoronary acetylcholine provocation test. Arch Cardiovasc Dis 2018; 111:144-154. [DOI: 10.1016/j.acvd.2017.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/14/2017] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
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Kamakura T, Wada M, Ishibashi K, Inoue YY, Miyamoto K, Okamura H, Nagase S, Noda T, Aiba T, Yasuda S, Shimizu W, Kamakura S, Kusano K. Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome. J Am Heart Assoc 2018; 7:JAHA.117.007942. [PMID: 29436392 PMCID: PMC5850201 DOI: 10.1161/jaha.117.007942] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave). METHODS AND RESULTS The study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow-up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF. CONCLUSIONS Approximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.
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Affiliation(s)
- Tsukasa Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Mitsuru Wada
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Kohei Ishibashi
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Yuko Y Inoue
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Koji Miyamoto
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Hideo Okamura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Satoshi Nagase
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Takashi Noda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Takeshi Aiba
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Satoshi Yasuda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Wataru Shimizu
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan.,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shiro Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
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Lujan HL, Rivers JP, DiCarlo SE. A single electrical pulse within the protective zone of each cardiac cycle prevented reperfusion-induced ventricular tachycardia in conscious mice. Physiol Rep 2018; 6. [PMID: 29380958 PMCID: PMC5789730 DOI: 10.14814/phy2.13578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/16/2017] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
Early pioneering investigators discovered, in anesthetized dogs, a protective period within the cardiac cycle. The protective period was a time within the cardiac cycle when a precisely timed stimulus prevented the initiation of ventricular fibrillation caused by an earlier stimulus. Thus, in addition to the susceptible period of repolarization discussed by Wiggers and Wegria (Am. J. Physiol. 131:296, 1940; Am. J. Physiol. 128:500, 1940), there is also a nearby protective period. This report describes a protective period within the cardiac cycle of conscious mice when a precisely timed stimulus prevented the initiation of ventricular tachycardia caused by an earlier stimulus. In addition, we tested the hypothesis that this precisely timed pulse within the protective period prevents reperfusion‐induced ventricular tachyarrhythmias in conscious mice. Mice (n = 6) were prepared to record arterial blood pressure and the electrocardiogram. In addition, a vascular occluder was placed around the left main coronary artery, and stimulating electrodes were secured onto the left ventricle. A single precisely timed electrical pulse (5 msec pulse width and 2.5 V) to the left ventricle arriving 13.9 ± 1.1 msec after the R‐wave, caused ventricular tachycardia occurring 24.9 ± 0.9 msec after the R‐wave. Importantly, a second precisely timed electrical pulse arriving 18.8 ± 0.5 msec after the first stimulus blocked the induction of ventricular tachycardia caused by the earlier stimulus. On an alternate day, the susceptibility to sustained ventricular tachycardia produced by 3.5 min of occlusion and reperfusion of the coronary artery was determined in conscious mice by use of the vascular occluder. Reperfusion resulted in ventricular tachycardia in all six mice. A precisely timed pulse within the protective period prevented ventricular tachycardia in all mice.
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Affiliation(s)
- Heidi L Lujan
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Joshua P Rivers
- Wayne State University School of Medicine, Detroit, Michigan
| | - Stephen E DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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50
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Sabzwari SRA, Varga Z, Butt K, Khan N. A Reversible Cause of Complete Heart Block Causing Chest Pain and Syncope. Cureus 2017; 9:e1953. [PMID: 29492349 PMCID: PMC5820009 DOI: 10.7759/cureus.1953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Vasospastic angina (VSA), also known as variant or Prinzmetal’s angina, is a relatively uncommon cause of retrosternal chest pain with transient ST segment elevation, mainly due to vasospasm in the coronary arteries. This is a case of 37-year-old female who presented with chest pain and syncope. Her initial workup, including echocardiogram, was negative. Subsequently, she was sent home with an event monitor. During the next two weeks, she continued to have recurrent episodes of similar chest pains and presented to her cardiology appointment with a heart rate of 45 bpm and blood pressure of 100/60 mmHg and was taken to hospital emergency department. Event monitor review showed intermittent complete heart block. In the hospital, the electrocardiogram (EKG) showed complete heart block and inferior lead ST elevations concomitantly with the chest pains. Although suspicious for vasospastic angina, coronary artery disease had to be ruled out for which patient underwent coronary angiography without evidence of significant obstructive disease. Immediately thereafter, the patient underwent permanent pacemaker placement without recurrence of syncopal episodes. This case signifies complete heart block as one of the rare complications of vasospastic angina which otherwise can also lead to symptoms such as dizziness, shortness of breath, syncope, cardiac arrest, and sudden cardiac death.
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Affiliation(s)
| | - Zoltan Varga
- Internal Medicine Residency, Florida Hospital-Orlando
| | - Khurram Butt
- Internal Medicine Residency, Florida Hospital-Orlando
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