1
|
The Biochemical Markers Associated with the Occurrence of Coronary Spasm. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4834202. [PMID: 31637257 PMCID: PMC6766173 DOI: 10.1155/2019/4834202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/28/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022]
Abstract
Coronary artery spasm (CAS) is one of the mechanisms of angina pectoris. Unlike the diagnosis of acute myocardial infarction which is based on the elevation of cardiac markers, the diagnosis of CAS is difficult and sometimes requires sophisticated and risky provocative test which is not widely accepted in China. There is no well-established biomarker for the diagnosis or prediction of CAS. However, there are some biomarkers proven to be associated with the occurrence of CAS. For example, inflammatory factors including C-reactive protein and cytokines, lipoprotein (a), and cystatin-C might be precipitating factor for CAS. Rho-kinase as a mediator involved in multiple mechanisms of CAS, serotonin, and endothelin-1 as powerful vasoconstrictors leading to vasospasm were all observed being elevated in patients with CAS. Thioredoxin and nitrotyrosine reflected the oxidative status and could be observed to be elevated after the occurrence of CAS. In some cases doubted to be CAS without the evidence of provocative test, the blood test for the biomarkers mentioned above could be useful for the diagnosis of CAS.
Collapse
|
2
|
Mishra S, Roguin A. Variant angina in chronic kidney disease: a case report of an unusual presentation of cardiac arrest following dialysis. Eur Heart J Case Rep 2017; 1:ytx013. [PMID: 31020071 PMCID: PMC6177017 DOI: 10.1093/ehjcr/ytx013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/22/2017] [Indexed: 11/14/2022]
Abstract
Variant angina (VA) is described as a relatively benign syndrome of unprovoked chest pain and electrocardiographic (ECG) changes. Chronic kidney disease (CKD) may be associated with this syndrome. However, the incidence of severe manifestations of VA in this patient cohort with kidney disease has not been elucidated. Also, no description has been made of coronary vasospam in relation to dialysis sessions. Our patient, a young female with CKD, had an unusual history of angina following dialysis sessions and she suffered an acute coronary syndrome complicated by cardiac arrest. The diagnosis was made on the basis of her clinical features, dynamic ECG changes, and coronary angiogram findings, and the patient was managed medically. Severe manifestations of VA may occur in chronic kidney disease, and this should be kept in mind by the treating physician. The association of coronary vasospasm with dialysis needs further analysis.
Collapse
Affiliation(s)
- Snehil Mishra
- Department of Cardiology, Rambam Medical Center, HaAliya HaShniya St 8, Haifa 3109601, Israel
| | - Ariel Roguin
- Department of Cardiology, Rambam Medical Center, HaAliya HaShniya St 8, Haifa 3109601, Israel
- Department of Cardiology, B. Rappaport Faculty of Medicine, Technion Medical School, HaAliya HaShniya St 8, Haifa 3109601, Israel
| |
Collapse
|
3
|
Naruse H, Ishii J, Takahashi H, Kitagawa F, Okuyama R, Kawai H, Muramatsu T, Harada M, Yamada A, Motoyama S, Matsui S, Hayashi M, Sarai M, Watanabe E, Izawa H, Ozaki Y. Prognostic Value of Combination of Plasma D-Dimer Concentration and Estimated Glomerular Filtration Rate in Predicting Long-Term Mortality of Patients With Stable Coronary Artery Disease. Circ J 2017; 81:1506-1513. [DOI: 10.1253/circj.cj-16-1272] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroyuki Naruse
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
| | - Junnichi Ishii
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
| | | | - Fumihiko Kitagawa
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
| | | | - Hideki Kawai
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University School of Medicine
| | - Masahide Harada
- Department of Cardiology, Fujita Health University School of Medicine
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine
| | - Sadako Motoyama
- Department of Cardiology, Fujita Health University School of Medicine
| | - Shigeru Matsui
- Department of Cardiology, Fujita Health University School of Medicine
| | | | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Hideo Izawa
- Department of Cardiology, Banbuntane Houtokukai Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine
| |
Collapse
|
4
|
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.
Collapse
Affiliation(s)
- Akira Funayama
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Lee SN, Shin DI, Jung MH, Choi IJ, Seo SM, Her SH, Kim PJ, Moon KW, Yoo KD, Baek SH, Seung KB. Impact of cystatin-C level on the prevalence and angiographic characteristics of vasospastic angina in Korean patients. Int Heart J 2014; 56:49-55. [PMID: 25742943 DOI: 10.1536/ihj.14-213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cystatin-C, a marker of mild renal dysfunction, has been reported to be associated with cardiovascular diseases including vasospastic angina (VSA). We aimed to investigate the impact of cystatin-C level on the prevalence and angiographic characteristics of VSA in Korean patients.A total of 549 patients in the VA-KOREA (Vasospastic Angina in KOREA) registry who underwent ergonovine provocation tests were consecutively enrolled. Estimated glomerular filtration rate (eGFR) and levels of serum creatinine (Cr) and cystatin-C were assessed before angiography.The patients were classified into two groups: the VSA group (n = 149, 27.1%) and the non-VSA group (n = 400). Although eGFR and Cr levels were similar between the two groups, the VSA group had a significantly higher level of cystatin-C (P < 0.05). A high level of cystatin-C (second tertile, hazard ratio 1.432; 95% confidence interval [1.1491.805]; P = 0.026, third tertile, 1.947 [1.132-2.719]; P = 0.003) and current smoking (2.710 [1.415-4.098]; P < 0.001) were independently associated with the prevalence of VSA. Furthermore, the highest level of cystatin-C (> 0.96 ng/mL) had a significant impact on the incidence of multivessel spasm (2.608 [1.061-4.596]; P = 0.037).A high level of cystatin-C was independently associated with the prevalence of VSA and with a high-risk type of VSA in Korean patients, suggesting that proactive investigation of VSA should be considered for patients with mild renal dysfunction indicated by elevated cystatin-C.
Collapse
Affiliation(s)
- Su Nam Lee
- Department of Cardiovascular Medicine, The Catholic University of Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Chronic kidney disease stage is a modulator on the association between high-sensitivity C-reactive protein and coronary vasospastic angina. ScientificWorldJournal 2014; 2014:852507. [PMID: 24737995 PMCID: PMC3967392 DOI: 10.1155/2014/852507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/22/2014] [Indexed: 11/21/2022] Open
Abstract
The prevalence of coronary vasospasm and also the factors associated with coronary vasospasm in CKD is still unclear. In this cross-sectional study of 859 consecutive CKD patients with angina pectoris received coronary catheterization, we evaluated the factors associated with coronary vasospasm. Patients with vasospasm were older and had higher peripheral blood white cell counts, higher peripheral blood monocyte cell counts, higher haemoglobin levels, higher hs-CRP levels, and lower levels of serum creatinine than patients without vasospasm. The results of multivariate logistic regression analysis revealed that peripheral blood monocyte count and hs-CRP level were independently associated with coronary vasospasm in patients with stage 1 CKD. Only peripheral blood monocyte count but not hs-CRP was independently associated with coronary vasospasm in patients with stages 2 and 3 of CKD. In conclusion, peripheral blood monocyte count is independently associated with coronary vasospasm in patients with stage 1–3 CKD, whereas hs-CRP is only independently associated with coronary vasospasm in patients with stage 1 CKD.
Collapse
|
7
|
Sakamoto N, Iwaya S, Owada T, Nakamura Y, Yamauchi H, Hoshino Y, Mizukami H, Sugimoto K, Yamaki T, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Takeishi Y. A reduction of coronary flow reserve is associated with chronic kidney disease and long-term cardio-cerebrovascular events in patients with non-obstructive coronary artery disease and vasospasm. Fukushima J Med Sci 2013; 58:136-43. [PMID: 23237869 DOI: 10.5387/fms.58.136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Coronary flow reserve (CFR) provides essential information about the coronary microvasculature. Chronic kidney disease (CKD) is a risk factor for cardio-cerebrovascular diseases. We hypothesized that low CFR is associated with CKD and long-term cardio-cerebrovascular events in the patients without obstructive coronary artery diseases and vasospasm. METHOD AND RESULTS In this study, 73 patients suspected with coronary artery disease but had no epicardial coronary stenosis and vasospasm were enrolled. There were 13 CKD patients and CFR was measured using the Doppler flow wire methods in the left anterior descending artery. CFR was significantly lower in CKD group than non-CKD group (3.13 ± 0.6 vs. 4.00 ± 1.1, P = 0.007). From multivariate logistic regression analysis, the independent factor associated with the presence of CKD was only CFR (odds ratio 3.85, 95% confidence interval 1.27-11.70, P = 0.017). In the patients with low CFR (≤ 2.8), cardio-cerebrovascular events were more common than those with normal CFR (CFR > 2.8). Besides, in the patients who had both low CFR and CKD, long-term cardio-cerebrovascular events were more likely to occur than those with normal CFR or non-CKD. CONCLUSIONS Our data suggest that low CFR is associated with CKD and cardio-cerebrovascular events in the patients without coronary stenosis and vasospasm.
Collapse
Affiliation(s)
- Nobuo Sakamoto
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Dresen WF, Wells QS, Maron DJ, McPherson JA. Therapeutic procedures for coronary vasospasm-induced polymorphic ventricular tachycardia. Ther Adv Cardiovasc Dis 2012; 6:115-21. [PMID: 22547691 DOI: 10.1177/1753944712446303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Coronary vasospasm is an unusual cause of angina and myocardial ischemia, with the potential to provoke acute myocardial infarction, malignant cardiac arrhythmias, and sudden cardiac death. The diagnosis is largely clinical and requires a high index of suspicion. Provocation studies are rarely performed due to the risks of the procedure and the relatively low incidence of disease. A subset of patients does not respond to conventional medical therapy and a paucity of evidence exists to guide therapy. While generally believed a multifocal phenomenon, there have been reports of successful treatment of focal, refractory vasospasm with coronary stent implantation. Furthermore, consideration of an implantable cardioverter defibrillator is warranted when vasospasm is complicated by lethal ventricular arrhythmias.
Collapse
Affiliation(s)
- William F Dresen
- Vanderbilt University Medical Center, 905 Derby Trace, Nashville, TN 37211, USA.
| | | | | | | |
Collapse
|
9
|
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
| |
Collapse
|