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He Z, Xu X, Zhao Q, Ding H, Wang DW. Vasospastic angina: Past, present, and future. Pharmacol Ther 2023; 249:108500. [PMID: 37482097 DOI: 10.1016/j.pharmthera.2023.108500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
Vasospastic angina (VSA) is characterized by episodes of rest angina that are responsive to short-acting nitrates and are attributable to coronary artery vasospasm. The condition is underdiagnosed as the provocation test is rarely performed. VSA, the most important component of non-obstructive coronary artery disease, can present with angina, be asymptomatic, or can even present with fatal arrhythmias and cardiac arrest. Although most patients with VSA respond well to vasodilating medications, prognosis does not improve as expected in most patients, suggesting the existence elusive prognostic factors and pathogenesis that warrant further exploration. Moreover, patients with either severe or refractory VSA barely respond to conventional treatment and may develop life-threatening arrhythmias or suffer sudden cardiac death during ischemic attacks, which are associated with immune-inflammatory responses and have been shown to achieve remission following glucocorticoid and immunoglobulin treatments. Our recent work revealed that inflammation plays a key role in the initiation and development of coronary spasms, and that inflammatory cytokines have predictive value for diagnosis. In contrast to the existing literature, this review both summarizes the theoretical and clinical aspects of VSA, and also discusses the relationship between inflammation, especially myocarditis and VSA, in order to provide novel insights into the etiology, diagnosis, and treatment of VSA.
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Affiliation(s)
- Zuowen He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Xin Xu
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Qu Zhao
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Hu Ding
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China.
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2
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Karimi Galougahi K, Dakroub A, Chau K, Mathew R, Mullasari A, Singh B, Sengottuvelu G, Maehara A, Mintz G, Jeremias A, Shlofmitz E, West NEJ, Shlofmitz R, Ali ZA. Utility of optical coherence tomography in acute coronary syndromes. Catheter Cardiovasc Interv 2023. [PMID: 37245076 DOI: 10.1002/ccd.30656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/29/2023]
Abstract
Studies utilizing intravascular imaging have replicated the findings of histopathological studies, identifying the most common substrates for acute coronary syndromes (ACS) as plaque rupture, erosion, and calcified nodule, with spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constituting the less common etiologies. The purpose of this review is to summarize the data from clinical studies that have used high-resolution intravascular optical coherence tomography (OCT) to assess culprit plaque morphology in ACS. In addition, we discuss the utility of intravascular OCT for effective treatment of patients presenting with ACS, including the possibility of culprit lesion-based treatment by percutaneous coronary intervention.
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Affiliation(s)
| | | | - Karen Chau
- St Francis Hospital, Roslyn, New York, USA
| | | | - Ajit Mullasari
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | | | - Akiko Maehara
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | | | | | | | - Richard Shlofmitz
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- St Francis Hospital, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
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3
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Xiang Y, Mendieta JB, Wang J, Paritala PK, Anbananthan H, Catano JAA, Fontanarosa D, Yarlagadda P, Li Z. Differences in Carotid Artery Geometry and Flow Caused by Body Postural Changes and Physical Exercise. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:820-830. [PMID: 36535833 DOI: 10.1016/j.ultrasmedbio.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
Different body postures and physical exercises may lead to changes in arterial geometry and hemodynamics, which may be associated with the distribution of atherosclerosis lesions. This study was aimed at investigating potential geometric and hemodynamic changes of the carotid bifurcation in different body postures and after high-intensity interval training (HIIT) workouts. Three-dimensional vascular ultrasound (3DVUS) and Doppler ultrasound images were acquired for 21 healthy participants (aged 29 ± 6 y, 14 men and 7 women) in different body postures (sitting and three sleeping postures [supine, left lateral and right lateral]) and after physical exercises. The common carotid artery (CCA) and internal carotid artery (ICA) diameters of the left carotid artery were found to increase significantly from supine to left lateral (both p <0.05). CCA diameters (p < 0.05) and ICA/CCA diameter ratio (p < 0.01) of the left carotid artery changed significantly from supine to sitting. Significant differences in CCA peak systolic velocity (CCA PSV, p < 0.001), CCA end-diastolic velocity (CCA EDV, p < 0.001), CCA pulsatility index (CCA PI, p < 0.001) and maximum velocity-based wall shear stress at the CCA (WSS(max) at the CCA, p < 0.001) were identified in different postures. After physical exercises, significant increases were observed in the CCA diameter (p < 0.001), CCA PSV (p < 0.001), ICA PSV (p < 0.05), WSS(max) at the CCA (p < 0.001) and WSS(max) at the ICA (p < 0.05), as were significantly lower values of the CCA EDV (p < 0.01) and ICA/CCA PSV ratio (p < 0.05). Side-to-side differences were also detected in different postural change scenarios and after physical exercise; more significant differences were found to occur only in the left-sided carotid artery. Significant differences were identified under postural change and after physical exercise among healthy adults, suggesting that daily activity has an effect on the carotid bifurcation. These changes may be associated with formation and development of carotid atherosclerosis. Moreover, these side differences might be severe for patients and worth further attention in clinical practice.
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Affiliation(s)
- Yuqiao Xiang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jessica Benitez Mendieta
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jiaqiu Wang
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Phani Kumari Paritala
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Haveena Anbananthan
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jorge Alberto Amaya Catano
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Davide Fontanarosa
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Prasad Yarlagadda
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zhiyong Li
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia; Faculty of Sports Science, Ningbo University, Ningbo, China.
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4
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Hung MY, Hung MJ. Relationship between Inflammation and Vasospastic Angina. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020318. [PMID: 36837519 PMCID: PMC9960836 DOI: 10.3390/medicina59020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple presentations, including sudden cardiac death. Despite investigations to explore its pathogenesis, no single mechanism has been found to explain the entire process of VSA occurrence. The roles of elevated local and systemic inflammation have been increasingly recognized in VSA. Treatment strategies to decrease local and systemic inflammation deserve further investigation.
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Affiliation(s)
- Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Ming-Jui Hung
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
- Correspondence:
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The Need to Shift from Morphological to Structural Assessment for Carotid Plaque Vulnerability. Biomedicines 2022; 10:biomedicines10123038. [PMID: 36551791 PMCID: PMC9776071 DOI: 10.3390/biomedicines10123038] [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: 10/13/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Degree of luminal stenosis is generally considered to be an important indicator for judging the risk of atherosclerosis burden. However, patients with the same or similar degree of stenosis may have significant differences in plaque morphology and biomechanical factors. This study investigated three patients with carotid atherosclerosis within a similar range of stenosis. Using our developed fluid-structure interaction (FSI) modelling method, this study analyzed and compared the morphological and biomechanical parameters of the three patients. Although their degrees of carotid stenosis were similar, the plaque components showed a significant difference. The distribution range of time-averaged wall shear stress (TAWSS) of patient 2 was wider than that of patient 1 and patient 3. Patient 2 also had a much smaller plaque stress compared to the other two patients. There were significant differences in TAWSS and plaque stresses among three patients. This study suggests that plaque vulnerability is not determined by a single morphological factor, but rather by the combined structure. It is necessary to transform the morphological assessment into a structural assessment of the risk of plaque rupture.
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E-cigarettes and their lone constituents induce cardiac arrhythmia and conduction defects in mice. Nat Commun 2022; 13:6088. [PMID: 36284091 PMCID: PMC9596490 DOI: 10.1038/s41467-022-33203-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/24/2022] [Indexed: 01/11/2023] Open
Abstract
E-cigarette use has surged, but the long-term health effects remain unknown. E-cigarette aerosols containing nicotine and acrolein, a combustion and e-cigarette byproduct, may impair cardiac electrophysiology through autonomic imbalance. Here we show in mouse electrocardiograms that acute inhalation of e-cigarette aerosols disturbs cardiac conduction, in part through parasympathetic modulation. We demonstrate that, similar to acrolein or combustible cigarette smoke, aerosols from e-cigarette solvents (vegetable glycerin and propylene glycol) induce bradycardia, bradyarrhythmias, and elevations in heart rate variability during inhalation exposure, with inverse post-exposure effects. These effects are slighter with tobacco- or menthol-flavored aerosols containing nicotine, and in female mice. Yet, menthol-flavored and PG aerosols also increase ventricular arrhythmias and augment early ventricular repolarization (J amplitude), while menthol uniquely alters atrial and atrioventricular conduction. Exposure to e-cigarette aerosols from vegetable glycerin and its byproduct, acrolein, diminish heart rate and early repolarization. The pro-arrhythmic effects of solvent aerosols on ventricular repolarization and heart rate variability depend partly on parasympathetic modulation, whereas ventricular arrhythmias positively associate with early repolarization dependent on the presence of nicotine. Our study indicates that chemical constituents of e-cigarettes could contribute to cardiac risk by provoking pro-arrhythmic changes and stimulating autonomic reflexes.
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Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081124. [PMID: 36013303 PMCID: PMC9409871 DOI: 10.3390/life12081124] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/26/2022]
Abstract
Vasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial dysfunction and smooth muscle hypercontractility lead to a broad spectrum of clinical manifestations ranging from recurrent angina to fatal arrhythmias. Invasive provocation testing using intracoronary acetylcholine or ergonovine is considered the current gold standard for diagnosis, but there is a wide variation in protocols amongst different institutions. Conventional pharmacological therapy relies on calcium channel blockers and nitrates; however, refractory VSA has limited options. This review evaluates the pathophysiology, diagnostic challenges, and management strategies for VSA. We believe global efforts to standardise diagnostic and therapeutic guidelines will improve the outcomes for affected patients.
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Chidyagwai SG, Vardhan M, Kaplan M, Chamberlain R, Barker P, Randles A. Characterization of hemodynamics in anomalous aortic origin of coronary arteries using patient-specific modeling. J Biomech 2022; 132:110919. [PMID: 35063831 PMCID: PMC10712838 DOI: 10.1016/j.jbiomech.2021.110919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022]
Abstract
The anomalous aortic origin of coronary arteries (AAOCA) is a congenital disease that can lead to sudden cardiac death (SCD) during strenuous physical activity. Despite AAOCA being the second leading cause of SCD among young athletes, the mechanism behind sudden cardiac death remains mostly unknown. Computational fluid dynamics provides a powerful tool for studying how pathologic anatomy can affect different hemodynamic states. The present study investigates the effect of AAOCA on patient hemodynamics. We performed patient-specific hemodynamic simulations of interarterial AAOCA at baseline and in the exercise state using our massively parallel flow solver. Additionally, we investigate how surgical correction via coronary unroofing impacts patient blood flow. Results show that patient-specific AAOCA models exhibited higher interarterial time-averaged wall shear stress (TAWSS) values compared to the control patients. The oscillatory shear index had no impact on AAOCA. Finally, the coronary unroofing procedure normalized the elevated TAWSS by decreasing TAWSS in the postoperative patient. The present study provides a proof of concept for the potential hemodynamic factors underlying coronary ischemia in AAOCA during exercise state.
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Affiliation(s)
- Simbarashe G Chidyagwai
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America.
| | - Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America.
| | - Michael Kaplan
- Duke University School of Medicine, Duke University, Durham, NC, United States of America.
| | - Reid Chamberlain
- Department of Medicine, Duke University, Durham, NC, United States of America; Department of Pediatrics, Duke University, Durham, NC, United States of America.
| | - Piers Barker
- Department of Medicine, Duke University, Durham, NC, United States of America; Department of Pediatrics, Duke University, Durham, NC, United States of America.
| | - Amanda Randles
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America.
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Abstract
Advances in intravascular imaging have enabled assessment of the underlying plaque morphology in acute coronary syndromes, which allows for the initiation of individualized therapy. The atherothrombotic substrates for acute coronary syndromes consist of plaque rupture, erosion, and calcified nodule, whereas spontaneous coronary artery dissection, coronary artery spasm, and coronary embolism constitute rarer nonatherothrombotic etiologies. This review provides a brief overview of the data from clinical studies that have used intravascular optical coherence tomography to assess the culprit plaque morphology. We discuss the usefulness of intravascular imaging for effective treatment of patients presenting with acute coronary syndromes by percutaneous coronary intervention.
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Hematological biomarkers for predicting carotid artery vasospasm during carotid stenting. Arch Med Sci Atheroscler Dis 2020; 5:e206-e211. [PMID: 32832722 PMCID: PMC7433789 DOI: 10.5114/amsad.2020.97722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The vasospasm of carotid arteries is important for the progression of neurological sequelae. Many mechanisms have been found to be related to this clinical phenomenon. Predicting this event by using hematological biomarkers may provide opportunities for adopting preventive measures against unfavorable neurovascular complications. The aim of this study is to determine the hematological predictors of carotid artery vasospasm during carotid stenting. Material and methods A total of 120 patients who underwent carotid stenting were divided into two groups: those with and without carotid artery vasospasm. Carotid artery vasospasm was angiographically defined as transient or persistent emergent stenosis or irregularity of the vessel wall without evidence of thrombosis during carotid stenting. The hematological parameters were compared between 21 patients who developed carotid artery vasospasm (17.5%) and 99 patients who did not (82.5%). Results The mean age of the patients with carotid artery vasospasm and without carotid artery vasospasm was 66 ±8 and 70 ±8 years, respectively. Creatinine levels within 0.5–0.9 (OR = 3.704, 95% CI: 1.245–11.019, p = 0.019), each 1000 unit increase in neutrophil count (OR = 1.567, 95% CI: 1.027–2.392, p = 0.037) and presence of diabetes (OR = 3.081, 95% CI: 1.116–8.505, p = 0.030) were the independent predictors of carotid artery vasospasm in carotid arteries during carotid stenting. Conclusions The prediction of carotid artery vasospasm during carotid stenting should help clinicians adopt preventive measures against the development of neurological sequelae. This study found that creatinine levels, increased neutrophil count and presence of diabetes are independent predictors of carotid artery vasospasm.
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Matta A, Bouisset F, Lhermusier T, Campelo-Parada F, Elbaz M, Carrié D, Roncalli J. Coronary Artery Spasm: New Insights. J Interv Cardiol 2020; 2020:5894586. [PMID: 32508542 PMCID: PMC7245659 DOI: 10.1155/2020/5894586] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/27/2020] [Accepted: 04/18/2020] [Indexed: 12/30/2022] Open
Abstract
Coronary artery spasm (CAS) defined by a severe reversible diffuse or focal vasoconstriction is the most common diagnosis among INOCA (ischemia with no obstructive coronary artery disease) patients irrespective to racial, genetic, and geographic variations. However, the prevalence of CAS tends to decrease in correlation with the increasing use of medicines such as calcium channel blockers, angiotensin converting enzyme inhibitor, and statins, the controlling management of atherosclerotic risk factors, and the decreased habitude to perform a functional reactivity test in highly active cardiac catheterization centers. A wide spectrum of clinical manifestations from silent disease to sudden cardiac death was attributed to this complex entity with unclear pathophysiology. Multiple mechanisms such as the autonomic nervous system, endothelial dysfunction, chronic inflammation, oxidative stress, and smooth muscle hypercontractility are involved. Regardless of the limited benefits proffered by the newly emerged cardiac imaging modalities, the provocative test remains the cornerstone diagnostic tool for CAS. It allows to reproduce CAS and to evaluate reactivity to nitrates. Different invasive and noninvasive therapeutic approaches are approved for the management of CAS. Long-acting nondihydropyridine calcium channel blockers are recommended for first line therapy. Invasive strategies such as PCI (percutaneous coronary intervention) and CABG (coronary artery bypass graft) have shown benefits in CAS with significant atherosclerotic lesions. Combination therapies are proposed for refractory cases.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | - Frederic Bouisset
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Thibault Lhermusier
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Fran Campelo-Parada
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France
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Increased plasma xanthine oxidoreductase activity deteriorates coronary artery spasm. Heart Vessels 2018; 34:1-8. [PMID: 29936631 DOI: 10.1007/s00380-018-1207-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
Abstract
Increased reactive oxygen species (ROS) contributes to the development of endothelial dysfunction, which is involved in coronary artery spasm (CAS). Xanthine oxidoreductase (XOR) plays a pivotal role in producing both uric acid and ROS. However, the association between plasma XOR activity and CAS has not been elucidated. The aim of this study was to investigate whether plasma XOR activity is associated with CAS. We measured XOR activity in 104 patients suspected for CAS, who presented without significant coronary artery stenosis and underwent intracoronary acetylcholine provocation tests. CAS was provoked in 44 patients and they had significantly higher XOR activity as compared with those without CAS. The patients were divided into three groups based on the XOR activity. The prevalence rate of CAS was increased with increasing XOR activity. A multivariate logistic regression analysis showed that the 3rd tertile group exhibited a higher incidence of CAS as compared with the 1st tertile group [odds ratio (OR) 6.9, P = 0.001) and the 2nd tertile group (OR 3.2, P = 0.033) after adjustment for conventional CAS risk factors, respectively. The C index was significantly improved by the addition of XOR activity to the baseline model based on CAS risk factors. Furthermore, the 3rd tertile group had the highest incidence of severe spasm defined as total obstruction, flow-limiting stenosis, diffuse spasm, multivessel spasm, and/or lethal arrhythmia. This is a first report to elucidate the association of plasma XOR activity with CAS. Increased plasma XOR activity is significantly associated with CAS.
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Hung MJ. Fluctuations in the amplitude of ST-segment elevation in vasospastic angina: Two case reports. Medicine (Baltimore) 2017; 96:e6334. [PMID: 28296760 PMCID: PMC5369915 DOI: 10.1097/md.0000000000006334] [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: 11/26/2022] Open
Abstract
RATIONALE ST-segment elevation localizes an ischemic lesion to the coronary artery supplying the area of the myocardium reflected by the electrocardiographic leads. Dynamic ST-segment elevation can be due to severe transmural ischemia secondary to a thrombus, vasospasm, or a tightly fixed coronary artery lesion or a combination of these situations. PATIENT CONCERNS In this study, we report on two patients with angina who had fluctuations in ST-segment amplitude on serial electrocardiograms. The amplitude of ST-segment elevation varied between 1-20 mm. DIAGNOSES Vasospastic angina (VSA) was diagnosed based on electrocardiography and coronary angiography. INTERVENTIONS Calcium antagonists were prescribed for both patients. OUTCOMES No recurrent VSA was noted during outpatient follow-up. LESSONS VSA can be associated with fluctuations in the amplitude of ST-segment elevation, indicating dynamic coronary vasospasm in different locations and extensions in patients with VSA.
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Mizuno Y, Hokimoto S, Harada E, Kinoshita K, Yoshimura M, Yasue H. Variant Aldehyde Dehydrogenase 2 ( ALDH2*2) in East Asians Interactively Exacerbates Tobacco Smoking Risk for Coronary Spasm ― Possible Role of Reactive Aldehydes ―. Circ J 2017; 81:96-102. [DOI: 10.1253/circj.cj-16-0969] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuji Mizuno
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Eisaku Harada
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute
| | - Kenji Kinoshita
- School of Pharmaceutical Sciences, Mukogawa Women’s University
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Hirofumi Yasue
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute
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Poku N, Noble S. Myocardial infarction with non obstructive coronary arteries (MINOCA): a whole new ball game. Expert Rev Cardiovasc Ther 2016; 15:7-14. [DOI: 10.1080/14779072.2017.1266256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nana Poku
- Cardiology Division, Department of the Medical Specialties, University Hospital of Geneva, Geneva, Switzerland
| | - Stephane Noble
- Cardiology Division, Department of the Medical Specialties, University Hospital of Geneva, Geneva, Switzerland
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16
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Hokimoto S, Tabata N, Yamanaga K, Sueta D, Akasaka T, Tsujita K, Sakamoto K, Yamamoto E, Yamamuro M, Izumiya Y, Kaikita K, Kojima S, Matsui K, Ogawa H. Prevalence of coronary macro- and micro-vascular dysfunctions after drug-eluting stent implantation without in-stent restenosis. Int J Cardiol 2016; 222:185-194. [PMID: 27497093 DOI: 10.1016/j.ijcard.2016.07.221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim was to examine the prevalence and characteristics of epicardial vasomotor abnormality (EVA) and coronary microvascular dysfunction (CMD) including endothelium-dependent (EDCMD) or -independent (EICMD) in patients following a second-generation drug-eluting stent (second DES) implantation without in-stent restenosis. METHODS AND RESULTS In 105 patients who underwent second DES implantation in the left anterior descending coronary artery (74 men; mean age, 67.9±9.6years), and in 105 suspected angina patients without stenting (65 men; mean age 66.4±9.1years), we evaluated EVA using the acetylcholine provocation test, EDCMD and EICMD by measuring the coronary flow reserve and the relationship between myocardial ischemia (intracoronary lactate production between aorta and coronary sinus and ST-T changes) or recurrent angina and vascular function. There was no difference in the incidence of EVA between DES and control (49.5% versus 55.2%; P=0.41). Given that the prevalence of CMD was higher in DES than in control (59.0% versus 29.5%; P<0.001), CMD may be associated with stent placement. Of the CMD patients, EDCMD alone, EICMD alone, and both CMDs were found in 40.3%, 22.6%, and 37.1%, respectively. Myocardial ischemia was detected in 42.4% of patients, and recurrent angina was more common in the presence of both EDCMD and EICMD in patients with EVA or CMD compared to patients with normal vascular function (EVA, 42.9% versus 7.7%, P=0.015: CMD, 39.1% versus 7.7%, P=0.007). CONCLUSIONS Myocardial ischemia and recurrent angina may be caused by the presence of both EDCMD and EICMD after a second DES implantation without ISR.
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Affiliation(s)
- Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomonori Akasaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Megumi Yamamuro
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kunihiko Matsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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17
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Mizuno Y, Hokimoto S, Harada E, Kinoshita K, Nakagawa K, Yoshimura M, Ogawa H, Yasue H. Variant Aldehyde Dehydrogenase 2 (ALDH2*2) Is a Risk Factor for Coronary Spasm and ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2016; 5:e003247. [PMID: 27153870 PMCID: PMC4889196 DOI: 10.1161/jaha.116.003247] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mitochondrial aldehyde dehydrogenase 2 (ALDH2) plays a key role in removing toxic aldehydes. Deficient variant ALDH2*2 genotype is prevalent in up to 40% of the East Asians and reported to be associated with acute myocardial infarction (AMI). To elucidate the mechanisms underlying the association of ALDH2*2 with AMI, we compared the clinical features of AMI patients with ALDH2*2 to those with wild-type ALDH2*1/*1. METHODS AND RESULTS The study subjects consisted of 202 Japanese patients with acute ST-segment elevation myocardial infarction (STEMI) (156 men and 46 women; mean age, 67.3±12.0) who underwent primary percutaneous coronary intervention (PCI). In 85 patients, provocation test for coronary spasm was also done 6 month post-PCI. ALDH2 genotyping was performed by direct application of the TaqMan polymerase chain system. Of the 202 patients, 103 (51.0%) were carriers of ALDH2*2 and 99 (49.0%) those of ALDH2*1/*1. There were no differences in clinical features between ALDH2*2 and ALDH2*1/*1 carrier groups except higher frequencies of coronary spasm and alcohol flush syndrome (AFS) (88.6% vs 56.1%; P=0.001 and 94.3% vs 17.6%; P<0.001), less-frequent alcohol habit (14.6% vs 51.5%; P<0.001), and higher peak plasma creatine phophokinase levels (2224 vs 1617 mg/dL; P=0.002) in the ALDH2*2 than the ALDH2*1/*1 carrier group. CONCLUSIONS ALDH2*2 is prevalent (51.0%) among Japanese STEMI patients, and those with ALDH2*2 had higher frequencies of coronary spasm and AFS and more-severe myocardial injury compared to those with ALDH2*1/*1.
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Affiliation(s)
- Yuji Mizuno
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Faculty of Life Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eisaku Harada
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan
| | - Kenji Kinoshita
- School of Pharmaceutical Sciences, Mukogawa Women's University, Koshien Nishinomiya, Japan
| | - Kazuko Nakagawa
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Faculty of Life Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Yasue
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan
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18
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Kanwar SS, Stone GW, Singh M, Virmani R, Olin J, Akasaka T, Narula J. Acute coronary syndromes without coronary plaque rupture. Nat Rev Cardiol 2016; 13:257-65. [PMID: 26911330 DOI: 10.1038/nrcardio.2016.19] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The latest advances in plaque imaging have provided clinicians with opportunities to treat acute coronary syndrome (ACS) and provide individualized treatment recommendations based not only on clinical manifestations, angiographic characteristics, and biomarker data, but also on the findings of plaque morphology. Although a substantial proportion of ACS events originate from plaques with an intact fibrous cap (IFC), clinicians predominantly equate ACS with plaque rupture arising from thin-cap fibroatheromas. In this Review, we discuss the recent advances in our understanding of plaque morphology in ACS with IFC, reviewing contemporary data from intravascular imaging. We also explore whether use of such imaging might provide a roadmap for more effective management of patients with ACS.
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Affiliation(s)
- Siddak S Kanwar
- Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029, USA
| | - Gregg W Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, 161 Washington Avenue, New York, New York 10032, USA
| | - Mandeep Singh
- Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Renu Virmani
- CVPath Institute, 19 Firstfield Road, Gaithersburg, Maryland 20878, USA
| | - Jeffrey Olin
- Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029, USA
| | - Takashi Akasaka
- Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, New York 10029, USA
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19
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Yasue H, Mizuno Y, Harada E. Letter by Yasue et al regarding article, "Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries". Circulation 2015; 131:e323. [PMID: 25623130 DOI: 10.1161/circulationaha.114.011332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hirofumi Yasue
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto City, Japan
| | - Yuji Mizuno
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto City, Japan
| | - Eisaku Harada
- Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto City, Japan
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20
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Funayama A, Watanabe T, Otaki Y, Nishiyama S, Arimoto T, Takahashi H, Shishido T, Miyamoto T, Kubota I. Utility of the Japan arteriosclerosis longitudinal study score for identifying a high risk for vasospastic angina. Intern Med 2015; 54:881-5. [PMID: 25876567 DOI: 10.2169/internalmedicine.54.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether the Japan Arteriosclerosis Longitudinal Study (JALS) score, which is calculated from the traditional atherosclerotic coronary risk, is associated with the incidence of coronary vasospasms. METHODS We performed vasospasm provocation tests with acetylcholine in 109 patients referred to our hospital due to suspected vasospastic angina and subsequently calculated the atherosclerotic risk score according to the JALS score. Consequently, coronary vasospasms were evoked in 51 patients. The patients were divided into three groups according to the tertile of the JALS score: 1st, <28, n=36; 2nd, 28-41, n=36, 3rd, >42, n=37. The third tertile exhibited the greatest risk for vasospasms. A multivariate logistic regression analysis revealed that the JALS score (odds ratio: 1.686, p<0.05) was independently associated with the incidence of vasospasms. CONCLUSION The JALS score can serve as a useful tool for evaluating patients with suspected coronary vasospasms.
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Affiliation(s)
- Akira Funayama
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Japan
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21
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Abstract
Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes total or subtotal vessel occlusion, plays an important role in myocardial ischemic syndromes including stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Coronary angiography and provocative testing usually is required to establish a definitive diagnosis. While the mechanisms underlying the development of CAS are still poorly understood, CAS appears to be a multifactorial disease but is not associated with the traditional risk factors for coronary artery disease. The diagnosis of CAS has important therapeutic implications, as calcium antagonists, not β-blockers, are the cornerstone of medical treatment. The prognosis is generally considered benign; however, recurrent episodes of angina are frequently observed. We provide a review of the literature and summarize the current state of knowledge regarding the pathogenesis of CAS.
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Affiliation(s)
- Ming-Jui Hung
- 1. Department of Cardiology, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Patrick Hu
- 2. International Cardiovascular Institute, Las Vegas, Nevada, USA; ; 3. Department of Cardiology, Riverside Medical Clinic, Riverside, California, USA
| | - Ming-Yow Hung
- 4. Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; ; 5. Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; ; 6. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
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22
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MAHEMUTI AILIMAN, ABUDUREHEMAN KAILIBINUER, SCHIELE FRANCOIS, ECARNOT FIONA, ABUDUREYIMU SHAJIDAN, TANG BAOPEN, UPUR HALMURAT, MENEVEAU NICOLAS. Association Between Inflammatory Markers, Hemostatic Markers, and Traditional Risk Factors on Coronary Artery Spasm in Patients with Normal Coronary Angiography. J Interv Cardiol 2013; 27:29-35. [PMID: 24345233 DOI: 10.1111/joic.12086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- AILIMAN MAHEMUTI
- Department of Cardiology; First Affiliated Hospital of Xinjiang Medical University; Urumqi Xinjiang China
| | - KAILIBINUER ABUDUREHEMAN
- Department of Cardiology; First Affiliated Hospital of Xinjiang Medical University; Urumqi Xinjiang China
| | - FRANCOIS SCHIELE
- Department of Cardiology; EA3920 University of Franche-Comté Medical School; University Hospital Jean-Minjoz; Besançon France
| | - FIONA ECARNOT
- Department of Cardiology; EA3920 University of Franche-Comté Medical School; University Hospital Jean-Minjoz; Besançon France
| | - SHAJIDAN ABUDUREYIMU
- Department of Cardiology; First Affiliated Hospital of Xinjiang Medical University; Urumqi Xinjiang China
| | - BAOPEN TANG
- Department of Cardiology; First Affiliated Hospital of Xinjiang Medical University; Urumqi Xinjiang China
| | - HALMURAT UPUR
- College of TCM; Xinjiang Medical University; Urumqi Xinjiang China
| | - NICOLAS MENEVEAU
- Department of Cardiology; EA3920 University of Franche-Comté Medical School; University Hospital Jean-Minjoz; Besançon France
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23
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Kovacic JC, Fuster V. Smoking gun theory: angiographically normal or mild coronary plaque as a cause of myocardial infarction. Circulation 2012; 126:2918-20. [PMID: 23168415 DOI: 10.1161/circulationaha.112.150425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Aikpokpo N, Hill S, Sechtem U. Case report: acute coronary artery spasm in a patient in the setting of non-cardiac surgery. Clin Res Cardiol 2012; 101:683-6. [PMID: 22527090 DOI: 10.1007/s00392-012-0444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
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25
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Ito T, Terashima M, Kaneda H, Nasu K, Ehara M, Kinoshita Y, Ito T, Kimura M, Tanaka N, Habara M, Tsuchikane E, Suzuki T. In Vivo Assessment of Ergonovine-Induced Coronary Artery Spasm by 64-Slice Multislice Computed Tomography. Circ Cardiovasc Imaging 2012; 5:226-32. [DOI: 10.1161/circimaging.111.967075] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tsuyoshi Ito
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Mitsuyasu Terashima
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Hideaki Kaneda
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Kenya Nasu
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Mariko Ehara
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Yoshihisa Kinoshita
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Tatsuya Ito
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Masashi Kimura
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Nobuyoshi Tanaka
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Maoto Habara
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Etsuo Tsuchikane
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
| | - Takahiko Suzuki
- From the Toyohashi Heart Center, Toyohashi, Japan (Tsuyoshi Ito, M.T., K.N., M.E., Y.K., Tatsuya Ito, M.K., N.T., M.H., E.T., T.S.); Okinaka Memorial Institute for Medical Research, Tokyo, Japan (H.K.); and Tokyo Heart Center, Tokyo, Japan (H.K.)
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26
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Chang PH, Hung MJ, Yeh KY, Yang SY, Wang CH. Oxaliplatin-Induced Coronary Vasospasm Manifesting As Kounis Syndrome: A Case Report. J Clin Oncol 2011; 29:e776-8. [DOI: 10.1200/jco.2011.36.4265] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Pei-Hung Chang
- Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung, Taiwan
| | - Ming-Jui Hung
- Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung, Taiwan
| | - Kun-Yun Yeh
- Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung, Taiwan
| | - Shih-Ying Yang
- Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung, Taiwan
| | - Cheng-Hsu Wang
- Chang Gung Memorial Hospital, Keelung & Chang Gung University, College of Medicine, Keelung, Taiwan
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27
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Sudden cardiac arrest and syncope triggered by coronary spasm. Int J Cardiol 2011; 163:56-60. [PMID: 21664706 DOI: 10.1016/j.ijcard.2011.05.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/16/2011] [Accepted: 05/13/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with coronary spasm generally have a good prognosis, although it can result in sudden cardiac arrest (SCA) and syncope. We hypothesized that the nature of coronary spasm triggering lethal arrhythmias may be different from that which induces angina-only. METHODS Clinical characteristics were examined in patients who had experienced SCA (n = 18) or syncope (n = 28) triggered by coronary spasm. These characteristics were compared to those of patients who had coronary spastic angina-only (n = 52). RESULTS SCA and syncope occurred frequently during daytime in 57% and 68%, respectively. Spontaneous ST-segment changes during daytime were recorded more often in patients with SCA (50%) and syncope (39%) than angina-only patients (4%, p < 0.01 for each). Nocturnal angina occurred less frequently in patients with SCA (33%) and syncope (32%) than angina-only patients (83%, p < 0.01 for each). Severe multivessel spasm, daytime ST-segment changes, and younger age were significant predictors of SCA. Daytime ST-segment changes and active smoking were related to syncope. CONCLUSIONS The circadian variance of coronary spasm triggering SCA or syncope may be different from that inducing typical coronary spastic angina. The coronary spasm should be evaluated for patients with aborted SCA or recurrent syncope of unknown cause, even though the patients have not experienced the typical nocturnal angina.
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28
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Funayama A, Watanabe T, Tamabuchi T, Otaki Y, Netsu S, Hasegawa H, Honda S, Ishino M, Arimoto T, Takahashi H, Shishido T, Miyamoto T, Nitobe J, Kubota I. Elevated Cystatin C Levels Predict the Incidence of Vasospastic Angina. Circ J 2011; 75:2439-44. [DOI: 10.1253/circj.cj-11-0008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akira Funayama
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Toshiaki Tamabuchi
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Yoichiro Otaki
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Shunsuke Netsu
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Hiromasa Hasegawa
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Shintaro Honda
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Mitsunori Ishino
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Takuya Miyamoto
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Joji Nitobe
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
| | - Isao Kubota
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine
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29
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Abstract
Abnormal coronary vasoconstriction, or coronary spasm, can be the result of several factors, including local and neuroendocrine aberrations. It can manifest clinically as a coronary syndrome and plays an important role in the genesis of myocardial ischemia. Over the past half century, coronary angiography allowed the in vivo demonstration of spasm in patients who fit the initial clinical description of the condition as reported by Prinzmetal et al. Several clinical, basic, and more recently, genetic studies have provided insight into the pathogenesis, manifestations, and therapy of this condition. It is not uncommonly encountered in patients with coronary syndromes and absence of clearly pathologic lesions on angiography. Provocation tests utilizing pharmacologic and nonpharmacologic stimuli combined with imaging (echocardiography or coronary angiography) can help make the correct diagnosis. The use of calcium channel blockers and long-acting nitrates is currently considered standard of care and the overall prognosis appears to be good. The recent discovery of genetic abnormalities predisposing to abnormal spasm of the coronaries has stimulated interest in the development of targeted therapies for the management of this condition.
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30
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Hung MJ. Current advances in the understanding of coronary vasospasm. World J Cardiol 2010; 2:34-42. [PMID: 21160682 PMCID: PMC2998866 DOI: 10.4330/wjc.v2.i2.34] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 02/10/2010] [Accepted: 02/19/2010] [Indexed: 02/06/2023] Open
Abstract
Recent years have witnessed progress in our understanding of coronary vasospasm (CVS). It is evident that this is not only an East Asian but also a global disease associated with significant symptoms and possible lethal sequelae for afflicted individuals. A correct diagnosis depends on the understanding of pathogenesis and symptomatology of CVS. With the correct diagnosis, we can manage CVS patients effectively and promptly, providing optimal patient safety. Advances in our understanding of interactions between inflammation, endothelium, and smooth muscle cells have led to substantial progress in understanding the pathogenesis of symptoms in CVS and have provided some insights into the basic etiology of this disorder in some patient subpopulations. We look forward to a time when therapy will address pathophysiology and perhaps, even the primary etiology.
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Affiliation(s)
- Ming-Jui Hung
- Ming-Jui Hung, Cardiology Section, Department of Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Keelung 20401, Taiwan, China
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