Insulin resistance relates to acetylcholine-induced microvascular vasoconstriction in a patient with vasospastic angina: potential implication of causalities between hyperinsulinemia and coronary microcirculation failure
Insulin resistance relates to acetylcholine-induced microvascular vasoconstriction in a patient with vasospastic angina: potential implication of causalities between hyperinsulinemia and coronary microcirculation failure
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DOI：
10.1007/s00380-004-0784-6
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发表时间：
2005-03-01
影响因子：
1.5
通讯作者：
Kitabatake, A
中科院分区：
文献类型：
--
作者：
Oyama, N;Urasawa, K;Kitabatake, A
在一名69岁的吸烟男性患者中研究了冠状动脉血管对乙酰胆碱输注的反应，该患者对口服葡萄糖负荷的胰岛素反应增强。冠状动脉造影显示无明显狭窄。在右冠状动脉中输注20 μ g乙酰胆碱后，在没有心外膜冠状动脉阻塞的情况下，立即出现血管造影无血流、缺血性心电图变化和心绞痛。虽然冠状动脉内输注硝酸异山梨酯仅部分有效，但冠状动脉内输注尼可地尔（一种已知可改善冠状动脉微循环的药物）可完全解决这些变化。这是迄今为止报道的第一例，表明增强的胰岛素反应可能与乙酰胆碱诱导的微血管收缩有关。当胰岛素抵抗患者出现胸痛时，必须考虑微血管收缩。
Coronary vasomotor response to acetylcholine infusion was studied in a 69-year-old currently smoking man with enhanced insulin response to oral glucose load. Coronary angiogram showed no significant stenoses. Immediately after 20 mu g acetylcholine infusion in the right coronary artery, angiographic no-flow, ischemic electrocardiographic changes, and anginal pain developed in the absence of epicardial coronary obstruction. While intracoronary infusion of isosorbide dinitrate was only partially effective, intracoronary infusion of nicorandil, an agent known to improve coronary microcirculation, completely resolved these changes. This is the first case reported so far suggesting that enhanced insulin response may be associated with acetylcholine-induced microvascular vasoconstriction. Microvascular vasoconstriction must be considered when a patient with insulin resistance presents with chest pain.