Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome.
Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome.
复制标题
DOI：
10.1161/jaha.117.007942
复制
发表时间：
2018-02-07
影响因子：
5.4
通讯作者：
Kusano K
中科院分区：
文献类型：
--
作者：
Kamakura T;Wada M;Ishibashi K;Inoue YY;Miyamoto K;Okamura H;Nagase S;Noda T;Aiba T;Yasuda S;Shimizu W;Kamakura S;Kusano K
先前描述的早期复极综合征（ERS）患者可能发生了无症状冠状动脉痉挛（CAS），因为CAS的诊断主要基于症状或冠状动脉造影结果，而没有进行痉挛激发试验。本研究探讨了CAS诊断的意义，并评估了可能存在ERS（即特发性室颤[VF]和下外侧J波）的患者中无症状CAS的发生率。研究包括34例特发性VF和下外侧J波。13例患者（38%）根据冠状动脉造影伴痉挛激发试验（n=8）和自发性ST段抬高记录（n=5）诊断为CAS。在13例CAS患者中，5例（38%）在VF之前和期间未出现胸部症状，并被诊断为无症状CAS。其余21名患者（62%）的激发试验结果为阴性且无胸部症状，被认为患有ERS。在92个月的随访期间，接受抗心绞痛药物适当治疗的CAS患者显示出良好的结局。相反，21例ERS患者中有4例（19%）VF复发。在4例ERS患者中，使用奎尼丁、西洛他唑和苄普地尔单药或联合治疗可有效抑制VF。大约40%的有VF和下外侧J波的CAS患者在第一次VF时没有胸部症状，可能被误诊为ERS。痉挛激发试验的使用被认为是区分患者以获得最佳药物治疗的必要条件。
Previously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave). The study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF. Approximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.