RESUMEN
BACKGROUND: An association between early repolarization and ventricular fibrillation has recently been reported in patients with vasospastic angina (VSA). However, no studies have clarified whether the presence of early repolarization can predict VSA. METHODS: Participants comprised 286 patients (136 males) with clinically suspected VSA who underwent intracoronary provocation tests using acetylcholine or ergonovine. Patients were divided into a VSA group [n = 94, positive provocation test as induction of coronary arterial spasm (>90% stenosis)] and a non-VSA group (n = 192). Detailed early repolarization data were compared between groups. RESULTS: The VSA group showed a higher frequency of smokers (28.7%) than the non-VSA group (17.2%; P = 0.02). On baseline 12-lead ECG, early repolarization (defined as a J-point elevation ≥0.1 mV from baseline in both or either of inferolateral leads) was found in 39 patients (inferior leads, n = 27; inferolateral leads, n = 12). Early repolarization was found more frequently in the VSA group (28.7%) than in the non-VSA group (6.2%, P < 0.01). Multivariate analysis revealed early repolarization as an independent predictor of VSA (odds ratio, 5.22; 95% confidence interval, 2.41-11.2; P < 0.01). Early repolarization pattern features including inferior lead, higher amplitude, notched type and horizontal/descending ST segments were associated with increased risk of VSA. CONCLUSION: In patients with resting chest pain, early repolarization was a predictor of VSA that could be particularly related to the inferior lead, higher amplitude, notched type and horizontal/descending ST segment.
Asunto(s)
Angina Pectoris Variable/fisiopatología , Vasoespasmo Coronario/fisiopatología , Electrocardiografía , Acetilcolina , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fibrilación Ventricular/fisiopatologíaRESUMEN
Impaired glucose metabolism is associated with an increased risk of cardiovascular complications, and coronary artery spasm is thought to underlie the development of coronary artery disease. Intraday glucose variability (GV) accelerates oxidative stress and inflammatory cytokine release, but its impact on coronary artery spasm remains unclear. This study investigated the relationship between intraday GV and coronary artery spasm. The study included 50 patients with dysglycemia and suspected coronary spastic angina. GV was analyzed by 24-h monitoring of the blood glucose concentration using a flash glucose monitoring system. The mean amplitude of glycemic excursion (MAGE) was calculated as an index of GV. Coronary artery spasm was assessed using the intracoronary acetylcholine provocation test. Coronary spasm was defined as acetylcholine-induced total or subtotal coronary occlusion. Changes in vessel diameter in response to acetylcholine were evaluated with quantitative coronary angiography. Coronary artery spasms were observed in 21 patients (42%). MAGE was significantly higher in patients with spasms compared to those without spasms (127.5 ± 33.5 vs. 91.4 ± 37.6, p < 0.01). Regression analysis showed a positive correlation between MAGE levels and coronary diameter changes induced by acetylcholine (r = 0.47, p < 0.01). In multiple regression analysis, MAGE was independently associated with acetylcholine-induced coronary diameter change (ß = 0.47, p < 0.01). Intraday GV was associated with coronary artery spasm in patients with dysglycemia.
Asunto(s)
Acetilcolina/farmacología , Angina Pectoris Variable/fisiopatología , Glucemia/análisis , Vasoespasmo Coronario/etiología , Diabetes Mellitus Tipo 2/complicaciones , Anciano , Análisis de Varianza , Angina Pectoris Variable/diagnóstico , Biomarcadores/sangre , Automonitorización de la Glucosa Sanguínea , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Vasoespasmo Coronario/sangre , Vasoespasmo Coronario/inducido químicamente , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Vasoconstricción/efectos de los fármacosRESUMEN
BACKGROUND: ST-segment elevation (STE) and an increased Tpeak-Tend interval (Tp-e) have prognostic value for malignant arrhythmia events (MAEs) in patients with ST-segment elevation myocardial infarction (STEMI) and Brugada syndrome. Whether STE could predict MAEs and has an electrophysiological relationship with Tp-e in electrocardiogram (ECG) of vasospastic angina (VA) patients needs to be elucidated. METHODS: Sixty-five patients with VA and 23 patients with VA complicated by MAEs were enrolled. The relationship of ECG parameters and MAEs (defined as ventricular tachycardia/ventricular fibrillation (VT/VF), syncope, and aborted sudden death) was analyzed by t-test, regression and receiver operating characteristic (ROC) curve analyses. RESULTS: Patients with MAEs showed greater STE (P<0.001) and corrected QT dispersion (cQTd) (P=0.021), a longer corrected Tp-e interval (cTp-e) (P<0.001), and a larger Tp-e/QT ratio (P<0.001) than those in non-MAE groups. Univariate analysis revealed that cQTd (odds ratio (OR)=1.065; P=0.020), cTp-e (OR=1.159; P=0.001), Tp-e/QT (OR=1.344, P=0.002), and STE (OR=5.655, P<0.001) were significantly associated with MAEs. In the multivariate analysis, Tp-e/QT and STE remained predictors of MAEs. ROC curve analysis showed that the areas under curve (AUCs) for Tp-e/QT (AUC=0.944) and STE (AUC=0.974) were not significantly different (P>0.05), but both were significantly different than AUCs for cQTd (AUC=0.724) and cTp-e (AUC=0.841) (all P<0.05). STE was well fitted with the Tp-e/QT ratio in a multivariable linear regression model. CONCLUSIONS: STE and increased Tp-e/QT ratio had related electrophysiological properties and were independent prognostic indicators of MAEs in patients with VA.
Asunto(s)
Angina Pectoris Variable/fisiopatología , Arritmias Cardíacas/fisiopatología , Síndrome de Brugada/fisiopatología , Vasoespasmo Coronario/fisiopatología , Electrocardiografía , Infarto del Miocardio con Elevación del ST/fisiopatología , Adulto , Anciano , Angina Pectoris Variable/complicaciones , Arritmias Cardíacas/etiología , Síndrome de Brugada/complicaciones , Angiografía Coronaria , Vasoespasmo Coronario/complicaciones , Muerte Súbita Cardíaca/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/complicacionesRESUMEN
BACKGROUND: This study aimed to evaluate the effect of adenosine on epicardial coronary artery diameter during ergonovine provocation testing. METHODS: A total of 158 patients who underwent an ergonovine provocation test with intracoronary adenosine injection between 2011 and 2014 were selected. Patients were divided into four groups based on the severity of percent diameter stenosis following intracoronary ergonovine administration: Group 1, induced spasm < 50%; Group 2, 50-89%; Group 3, 90-99%; and Group 4, total occlusion. RESULTS: Spasm positivity was observed in 44 (27.8%) cases in the study population (mean age, 57.4 ± ± 10.7 years). Intracoronary adenosine increased the diameter of the ergonovine-induced epicardial artery by 0.51 ± 0.31 mm, 0.73 ± 0.39 mm, 0.44 ± 0.59 mm, and 0.01 ± 0.04 mm in Groups 1, 2, 3, and 4, respectively. Subsequent administration of nitroglycerin further increased vessel diameter by 0.49 ± 0.28 mm, 0.93 ± 0.68 mm, 2.11 ± 1.25 mm, and 2.23 ± 0.69 mm in Groups 1, 2, 3, and 4, respectively. The ratios of adenosine-induced diameter to reference diameter were significantly lower in patients with spasm positive results (0.68 [0.59-0.76] vs. 0.18 [0.00-0.41], p < 0.001 in the study population; 0.60 [0.54-0.67] vs. 0.40 [0.27-0.44], p < 0.001 in Group 2) with the best cut-off value of 0.505 (sensitivity 0.955, specificity 0.921). CONCLUSIONS: Intracoronary administration of adenosine dilated the ergonovine-induced vasoconstricted epicardial coronary artery. The ratio of adenosine-induced diameter to reference diameter was significantly lower in patients with spasm positive results.
Asunto(s)
Adenosina/administración & dosificación , Angina Pectoris Variable/diagnóstico por imagen , Angiografía Coronaria , Vasoespasmo Coronario/diagnóstico por imagen , Vasos Coronarios/efectos de los fármacos , Vasos Coronarios/diagnóstico por imagen , Ergonovina/administración & dosificación , Vasoconstricción/efectos de los fármacos , Vasoconstrictores/administración & dosificación , Vasodilatación/efectos de los fármacos , Vasodilatadores/administración & dosificación , Anciano , Angina Pectoris Variable/fisiopatología , Vasoespasmo Coronario/fisiopatología , Vasos Coronarios/fisiopatología , Femenino , Reserva del Flujo Fraccional Miocárdico/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
Vasospastic angina (VSA) is a variant form of angina pectoris, in which angina occurs at rest, with transient electrocardiogram modifications and preserved exercise capacity. VSA can be involved in many clinical scenarios, such as stable angina, sudden cardiac death, acute coronary syndrome, arrhythmia or syncope. Coronary vasospasm is a heterogeneous phenomenon that can occur in patients with or without coronary atherosclerosis, can be focal or diffuse, and can affect epicardial or microvasculature coronary arteries. This disease remains underdiagnosed, and provocative tests are rarely performed. VSA diagnosis involves three considerations: classical clinical manifestations of VSA; documentation of myocardial ischaemia during spontaneous episodes; and demonstration of coronary artery spasm. The gold standard diagnostic approach uses invasive coronary angiography to directly image coronary spasm using acetylcholine, ergonovine or methylergonovine as the provocative stimulus. Lifestyle changes, avoidance of vasospastic agents and pharmacotherapy, such as calcium channel blockers, nitrates, statins, aspirin, alpha1-adrenergic receptor antagonists, rho-kinase inhibitors or nicorandil, could be proposed to patients with VSA. This review discusses the pathophysiology, clinical spectrum and management of VSA for clinicians, as well as diagnostic criteria and the provocative tests available for use by interventional cardiologists.
Asunto(s)
Angina Pectoris Variable , Vasos Coronarios , Angina Pectoris Variable/diagnóstico por imagen , Angina Pectoris Variable/epidemiología , Angina Pectoris Variable/fisiopatología , Angina Pectoris Variable/terapia , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/efectos de los fármacos , Vasos Coronarios/fisiopatología , Electrocardiografía , Medicina Basada en la Evidencia , Tolerancia al Ejercicio , Humanos , Valor Predictivo de las Pruebas , Prevalencia , Pronóstico , Factores de Riesgo , Conducta de Reducción del Riesgo , Vasoconstricción , Vasodilatadores/uso terapéuticoAsunto(s)
Angina Pectoris Variable/fisiopatología , Dolor en el Pecho/fisiopatología , Reestenosis Coronaria/fisiopatología , Vasoespasmo Coronario/diagnóstico , Electrocardiografía , Taquicardia/fisiopatología , Angina Pectoris Variable/diagnóstico por imagen , Angina Pectoris Variable/terapia , Dolor en el Pecho/diagnóstico por imagen , Dolor en el Pecho/etiología , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/terapia , Vasoespasmo Coronario/diagnóstico por imagen , Vasoespasmo Coronario/fisiopatología , Vasoespasmo Coronario/terapia , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Resultado del TratamientoAsunto(s)
Angina Pectoris Variable/complicaciones , Paro Cardíaco/etiología , Enfermedad de Moyamoya/complicaciones , Angina Pectoris Variable/diagnóstico por imagen , Angina Pectoris Variable/tratamiento farmacológico , Angina Pectoris Variable/fisiopatología , Angiografía Cerebral , Infarto Cerebral/etiología , Angiografía Coronaria , Imagen de Difusión por Resonancia Magnética , Femenino , Paro Cardíaco/diagnóstico por imagen , Humanos , Enfermedad de Moyamoya/diagnóstico por imagen , Resultado del Tratamiento , Vasodilatadores/uso terapéutico , Adulto JovenAsunto(s)
Angina Pectoris Variable/diagnóstico por imagen , Vasoespasmo Coronario/diagnóstico por imagen , Angina Pectoris Variable/tratamiento farmacológico , Angina Pectoris Variable/fisiopatología , Angiografía , Calcio/agonistas , Vasoespasmo Coronario/fisiopatología , Diagnóstico Diferencial , Humanos , Isosorbida/uso terapéutico , Masculino , Persona de Mediana EdadAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Vasoespasmo Coronario/diagnóstico por imagen , Angina Pectoris Variable/diagnóstico por imagen , Angiografía , Calcio/agonistas , Vasoespasmo Coronario/fisiopatología , Diagnóstico Diferencial , Isosorbida/uso terapéutico , Angina Pectoris Variable/fisiopatología , Angina Pectoris Variable/tratamiento farmacológicoRESUMEN
Variant angina also called Prinzmetals angina is an enigma characterized by transient circadian symptoms of chest pain associated with ECG changes. The patient is symptom free with normal ECG and echo during symptom free periods. We present a case associated with transient ST-segment elevation with non critical lesion with normal FFR.
Asunto(s)
Angina Pectoris Variable/diagnóstico por imagen , Angina Pectoris Variable/fisiopatología , Reserva del Flujo Fraccional Miocárdico/fisiología , Stents , Angina Pectoris Variable/cirugía , Electrocardiografía/métodos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Although coronary obstruction due to atherosclerosis is the most common cause of myocardial ischemia, a significant proportion of patients have myocardial ischemia in the absence of obstructive epicardial coronary artery disease (CAD). This finding is more common among women and alternative causes can mediate myocardial ischemia. Abnormalities in vascular structure, alterations in coronary vasomotion and dysfunction of the coronary microcirculation can all cause ischemia in the absence of obstructive CAD due to atherosclerosis. In this review, we provide an update on three alternative causes of myocardial ischemia: spontaneous coronary artery dissection (SCAD), vasospastic angina (VSA) and coronary microvascular dysfunction (CMVD). We review pathophysiology, clinical presentation, diagnosis, treatment and outcomes related to these important clinical entities. There is increasing interest in better defining this patient population with use of advanced imaging and testing tools. Despite the increased associated risk with future cardiac events, evidence-based treatments for these diagnoses remain under-studied and poorly defined. These alternative diagnoses should be kept in mind when evaluating women with myocardial ischemia without obstructive CAD due to atherosclerosis.
Asunto(s)
Angina Pectoris Variable/complicaciones , Circulación Coronaria , Anomalías de los Vasos Coronarios/complicaciones , Vasos Coronarios/fisiopatología , Disparidades en el Estado de Salud , Microcirculación , Isquemia Miocárdica/etiología , Enfermedades Vasculares/congénito , Angina Pectoris Variable/diagnóstico por imagen , Angina Pectoris Variable/fisiopatología , Angina Pectoris Variable/terapia , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/fisiopatología , Anomalías de los Vasos Coronarios/terapia , Vasos Coronarios/diagnóstico por imagen , Electrocardiografía , Femenino , Humanos , Masculino , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/terapia , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Factores Sexuales , Tomografía de Coherencia Óptica , Ultrasonografía Intervencional , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/fisiopatología , Enfermedades Vasculares/terapiaRESUMEN
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.
Asunto(s)
Angina Pectoris Variable/fisiopatología , Anciano , Angina Pectoris Variable/diagnóstico , Angina Pectoris Variable/tratamiento farmacológico , Bloqueadores de los Canales de Calcio/uso terapéutico , Vasoespasmo Coronario/fisiopatología , Electrocardiografía , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Angina Pectoris Variable/diagnóstico , Circulación Coronaria/fisiología , Vasos Coronarios/fisiopatología , Ecocardiografía Doppler/métodos , Flujo Sanguíneo Regional/fisiología , Angina Pectoris Variable/fisiopatología , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Electrocardiografía , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Angina Pectoris Variable/prevención & control , Oclusión Coronaria , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Angina Pectoris Variable/diagnóstico , Angina Pectoris Variable/etiología , Angina Pectoris Variable/fisiopatología , Oclusión Coronaria/complicaciones , Oclusión Coronaria/tratamiento farmacológico , Humanos , Índice de Severidad de la Enfermedad , Tiempo , Resultado del TratamientoAsunto(s)
Angina Pectoris Variable/diagnóstico , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Vasoespasmo Coronario/diagnóstico , Electrocardiografía Ambulatoria/métodos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Verapamilo/administración & dosificación , Adulto , Angina Pectoris Variable/etiología , Angina Pectoris Variable/fisiopatología , Angina Pectoris Variable/terapia , Vasoespasmo Coronario/complicaciones , Vasoespasmo Coronario/tratamiento farmacológico , Vasoespasmo Coronario/fisiopatología , Manejo de la Enfermedad , Humanos , Masculino , Resultado del Tratamiento , Vasodilatadores/administración & dosificaciónRESUMEN
BACKGROUND: High-dose aspirin has been reported to exacerbate coronary artery spasm in patients with vasospastic angina. We investigated clinical implications of low-dose aspirin on vasospastic angina patients without significant coronary artery stenosis. METHODS: We included patients without significant coronary artery stenosis on coronary angiography (CAG) and with positive results on intracoronary ergonovine provocation test between January 2003 and December 2014. A total of 777 patients were divided into two groups according to prescription of low-dose aspirin at discharge: aspirin group (n=321) and non-aspirin group (n=456). The major adverse cardiovascular events (MACE), defined as composite outcomes of cardiac death, acute myocardial infarction, revascularization, or rehospitalization requiring CAG or medication change due to recurrent angina were compared. RESULTS: The aspirin group had significantly higher incidence of MACE (22.8% versus 12.1%; p=0.04) and had higher tendency for rehospitalization (20.6% versus 11.2%; p=0.08). All-cause mortality and cardiac death were similar between the two groups. After propensity score matching, the aspirin group had greater risk of MACE (hazard ratio [HR] 1.54; 95% confidence interval [CI], 1.04-2.28; p=0.037) and rehospitalization requiring CAG (HR, 1.33; 95% CI, 1.13-4.20; p=0.03), and a higher tendency for rehospitalization (HR, 1.40; 95% CI, 0.94-2.09; p=0.12). CONCLUSION: In vasospastic angina without significant coronary artery stenosis, patients taking low-dose aspirin are at higher risk of MACE, driven primarily by tendency toward rehospitalization. Low-dose aspirin might be used with caution in vasospastic angina patients without significant coronary artery stenosis.
Asunto(s)
Angina Pectoris Variable , Aspirina , Estenosis Coronaria , Vasoespasmo Coronario , Vasos Coronarios , Angina Pectoris Variable/diagnóstico , Angina Pectoris Variable/tratamiento farmacológico , Angina Pectoris Variable/mortalidad , Angina Pectoris Variable/fisiopatología , Aspirina/administración & dosificación , Aspirina/efectos adversos , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/tratamiento farmacológico , Estenosis Coronaria/mortalidad , Estenosis Coronaria/fisiopatología , Vasoespasmo Coronario/diagnóstico , Vasoespasmo Coronario/tratamiento farmacológico , Vasoespasmo Coronario/mortalidad , Vasoespasmo Coronario/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/efectos de los fármacos , Vasos Coronarios/fisiopatología , Relación Dosis-Respuesta a Droga , Ergonovina/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxitócicos/farmacología , Readmisión del Paciente/estadística & datos numéricos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
Vasospastic angina is a diagnosis of exclusion that manifests with signs and symptoms, which overlap with obstructive coronary artery disease, most often ST-segment elevation myocardial infarction. The pharmacotherapy that is available to treat vasospastic angina can help ameliorate angina symptoms. However, the etiology of vasospastic angina is ill-defined, making targeted pharmacotherapy difficult. Most patients receive pharmacotherapy that includes calcium channel blockers and/or long-acting nitrates. This article reviews the efficacy and safety of the pharmacotherapy used to treat vasospastic angina. High-dose calcium channel blockers possess the most evidence, with respect to decreasing angina incidence, frequency, and duration. However, not all patients respond to calcium channel blockers. Nitrates and/or alpha1-adrenergic receptor antagonists can be used in patients who respond poorly to calcium channel blockers. Albeit, evidence for use of nitrates and alpha1-adrenergic receptor antagonists in vasospastic angina is not as robust as calcium channel blockers and can exacerbate adverse effects when added to calcium channel blocker therapy. Despite having a clear benefit in patients with obstructive coronary artery disease, the benefit of beta-adrenergic receptor antagonists, statins, and aspirin remains unclear. More data are needed to elucidate whether or not these agents are beneficial or harmful to patients being treated for vasospastic angina. Overall, the use of pharmacotherapy for the treatment of vasospastic angina should be guided by patient-specific factors, such as tolerability, adverse effects, drug-drug, and drug-disease interactions.
Asunto(s)
Angina Pectoris Variable/tratamiento farmacológico , Vasoespasmo Coronario/tratamiento farmacológico , Vasos Coronarios/efectos de los fármacos , Vasoconstricción/efectos de los fármacos , Vasodilatadores/uso terapéutico , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Angina Pectoris Variable/diagnóstico , Angina Pectoris Variable/etiología , Angina Pectoris Variable/fisiopatología , Animales , Bloqueadores de los Canales de Calcio/uso terapéutico , Vasoespasmo Coronario/diagnóstico , Vasoespasmo Coronario/etiología , Vasoespasmo Coronario/fisiopatología , Vasos Coronarios/fisiopatología , Humanos , Nitratos/uso terapéutico , Factores de Riesgo , Resultado del Tratamiento , Vasodilatadores/efectos adversosRESUMEN
BACKGROUND: We encounter a less provoked spasm in the left circumflex artery (LCX) by acetylcholine (ACh) testing compared with left anterior descending artery and right coronary artery (RCA) in the real world. OBJECTIVES: We investigated the clinical characteristics of provoked spasm in the LCX by ACh testing. METHODS: We retrospectively analyzed consecutive 1392 ACh testing over 20 years (1991-2011). The maximal ACh dose was 100 µg into the left coronary artery and 80 µg into the RCA. Positive spasm was defined as transient of more than or equal to 90% narrowing and usual chest symptoms or ischemic ECG changes. RESULTS: Positive provoked spasm was recognized in 622 patients (44.7%) including 456 RCA spasms, 448 left anterior descending artery spasms, and 176 LCX spasms. LCX-provoked spasm was significantly lower than other vessels (P<0.001). LCX-provoked spasm was observed in 176 patients, of whom 113 patients (64.2%) had triple-vessel spasm, 46 patients (26.1%) had double-vessel spasm, and 17 patients (9.7%) had single-vessel spasm. More than 90% patients with LCX-provoked spasm had multiple spasms. Of 17 patients with LCX single-vessel spasm, 15 patients (88.2%) had focal spasm. CONCLUSION: Under a maximal ACh dose of 100 µg into the left coronary artery, LCX-provoked spasm was significantly lower than other vessels and more than 90% of patients had multiple spasms.
Asunto(s)
Angina Pectoris Variable/diagnóstico por imagen , Vasoespasmo Coronario/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Vasoconstricción , Acetilcolina/administración & dosificación , Anciano , Angina Pectoris Variable/epidemiología , Angina Pectoris Variable/fisiopatología , Vasoespasmo Coronario/inducido químicamente , Vasoespasmo Coronario/epidemiología , Vasoespasmo Coronario/fisiopatología , Vasos Coronarios/efectos de los fármacos , Vasos Coronarios/fisiopatología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Vasoconstricción/efectos de los fármacos , Vasoconstrictores/administración & dosificaciónAsunto(s)
Implantes Absorbibles , Angina Pectoris Variable/etiología , Oclusión Coronaria/terapia , Estenosis Coronaria/terapia , Vasoespasmo Coronario/etiología , Intervención Coronaria Percutánea/instrumentación , Adulto , Angina Pectoris Variable/diagnóstico , Angina Pectoris Variable/tratamiento farmacológico , Angina Pectoris Variable/fisiopatología , Angiografía Coronaria , Oclusión Coronaria/diagnóstico , Oclusión Coronaria/fisiopatología , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/fisiopatología , Vasoespasmo Coronario/diagnóstico , Vasoespasmo Coronario/tratamiento farmacológico , Vasoespasmo Coronario/fisiopatología , Electrocardiografía , Humanos , Masculino , Diseño de Prótesis , Factores de Tiempo , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Vasodilatadores/uso terapéuticoRESUMEN
OBJECTIVE: To describe an unusual case of combined neuropathic and ischemia-induced chronic pain in a patient who was treated with one high thoracic paddle lead. BACKGROUND: To the best of our knowledge, the use of spinal cord stimulation (SCS) utilizing a single lead as a treatment strategy for combined Prinzmetal angina, a cardiac ischemia-induced disturbance of nociceptive perception, and diabetic neuropathy of the lower limbs has rarely been described. CASE REPORT: The underlying pain conditions and SCS technique used to treat both types of pain-Prinzmetal angina and lower-limb diabetic neuropathy-in a 73-year-old patient experiencing medical or interventional refractory complex pain syndrome are described. The SCS electrode was placed in the anatomical midline with a T2- to T3-level laminotomy and externalized for postoperative trial stimulation with systemic antibiotic administration. RESULTS: After 8 months, stable pain control was achieved. No complications occurred. CONCLUSION: We present a chronic pain syndrome due to combined Prinzmetal angina and diabetic neuropathy of the lower limbs with sustained pain relief utilizing a single SCS lead.