Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina
Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina
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DOI：
10.1016/s0735-1097(02)01690-x
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发表时间：
2002-03-06
影响因子：
24
通讯作者：
Takeshita, A
中科院分区：
文献类型：
--
作者：
Sun, HT;Mohri, M;Takeshita, A
我们的目的是检验冠状动脉微血管痉挛（MVS）单独引起心绞痛患者心肌缺血的假设，并确定有无微血管痉挛的患者的临床特征是否存在差异。背景“血管痉挛性心绞痛”患者有心外膜冠状动脉痉挛，方法对55例冠状动脉内注射乙酰胆碱（ACH）诱发心外膜冠状动脉痉挛的心绞痛患者进行研究。结果14例患者中，14例发生了心外膜痉挛，14例发生了心外膜痉挛，14例发生了心外膜痉挛，14例发生了心外膜痉挛。（25.5%，第1组），次最大剂量ACH诱导心肌缺血（胸痛、缺血性心电图变化、乳酸产生），无大面积心外膜痉挛，表明发生冠状动脉微血管痉挛。相比之下，其余41例患者（第2组）只有在血管造影证实心外膜痉挛时才有心肌缺血的证据。第I组患者主要为女性（p < 0.05）且有长期（>30分钟）胸痛史（p < 0.05），而第2组患者更可能是男性和吸烟者。结论：在相当一部分心外膜血管痉挛患者中，最可能由冠状动脉MVS引起的心肌缺血被证实，结果提示冠状动脉微血管疾病也可能导致“血管痉挛性心绞痛”患者的心绞痛。（C）2002年美国心脏病学会基金会。
OBJECTIVES We aimed to test die hypothesis that coronary microvascular spasm (MVS) alone causes myocardial ischemia in patients with angina attributable to epicardial coronary spasm, and to determine whether there is a difference in clinical characteristics between those with and without microvascular spasm.BACKGROUND Patients with "vasospastic angina" have epicardial coronary artery spasm, but it is unknown whether coronary microvessel disease also contributes to the occurrence of angina in these patients.METHODS We studied 55 consecutive patients with angina in whom epicardial coronary spasm was provoked by intracoronary acetylcholine (ACH).RESULTS In 14 patients (25.5%, Group 1), submaximal dose of ACH induced myocardial ischemia (chest pain, ischemic electrocardiogram changes, lactate production) without large epicardial spasm, suggesting the occurrence of coronary microvascular spasm. By contrast, the remaining 41 patients (Group 2) had evidence of myocardial ischemia only when epicardial spasm was angiographically demonstrated. The Group I patients were predominantly women (p < 0.05) and had a history of prolonged (>30 min) chest pain (p < 0.05), whereas the Group 2 patients were more likely men and smokers (p < 0.01).CONCLUSIONS Myocardial ischemia most probably due to coronary MVS was demonstrated in a sizable portion of patients with epicardial vasospasm, preferentially in women having both typical and prolonged anginal pain, The result suggests that coronary microvascular disease may also contribute to angina in patients with "vasospastic angina." (C) 2002 by the American College of Cardiology Foundation.