Epicardial atherosclerosis and coronary tortuosity in patients with acetylcholine-induced coronary spasm.
Journal
Coronary artery disease
ISSN: 1473-5830
Titre abrégé: Coron Artery Dis
Pays: England
ID NLM: 9011445
Informations de publication
Date de publication:
01 01 2023
01 01 2023
Historique:
entrez:
9
12
2022
pubmed:
10
12
2022
medline:
15
12
2022
Statut:
ppublish
Résumé
Angina pectoris in the absence of relevant epicardial stenoses is frequently caused by coronary spasm. This mechanism of angina is common yet underdiagnosed in daily clinical practice. The pathophysiology of coronary spasm is complex, multifactorial, and not completely understood. The purpose of this study was to analyze the relationship between macroscopic coronary morphologies and coronary spasm. Epicardial atherosclerosis, coronary vessel tortuosity, coronary aneurysms, and myocardial bridges were analyzed angiographically in 610 patients and a potential association with the result of an intracoronary acetylcholine (ACh) provocation test was investigated. The comparison showed that angiographic morphologic variations in the coronary arteries are related to the occurrence of coronary spasm. We observed a strong association between the presence of epicardial atherosclerosis and epicardial spasm [87 patients of 179 with epicardial spasm had epicardial atherosclerosis (49%) vs. 45 patients of 172 with microvascular spasm (26%) vs. 89 patients of 259 with negative/inconclusive ACh test (36%); P < 0.005]. Moreover, we found a higher frequency of coronary tortuosity in patients with microvascular spasm [99 patients of 172 with microvascular spasm had at least moderate coronary tortuosity (58%) vs. 76 patients of 179 with epicardial spasm (43%) vs. 126 patients of 259 with negative/inconclusive ACh test (49%); P = 0.017]. Multivariable analysis revealed epicardial atherosclerosis (<50% stenosis) on coronary angiography as a predictor for epicardial spasm (OR, 2.096; 95% CI, 1.467-2.995; P < 0.0005). Female sex (OR, 5.469; 95% CI, 3.433-8.713; P < 0.0005), and exertional angina (OR, 2.411; 95% CI, 1.597-3.639; P < 0.0005) were predictors of microvascular spasm in multivariable analysis. In angina patients with no obstructive coronary artery disease, epicardial atherosclerosis is associated with ACh-induced epicardial coronary spasm. Moreover, coronary microvascular spasm is more prevalent in female patients and those with exertional angina. Our results provide insights into the relationship between coronary morphology and coronary vasomotor function.
Sections du résumé
BACKGROUND
Angina pectoris in the absence of relevant epicardial stenoses is frequently caused by coronary spasm. This mechanism of angina is common yet underdiagnosed in daily clinical practice. The pathophysiology of coronary spasm is complex, multifactorial, and not completely understood. The purpose of this study was to analyze the relationship between macroscopic coronary morphologies and coronary spasm.
METHODS
Epicardial atherosclerosis, coronary vessel tortuosity, coronary aneurysms, and myocardial bridges were analyzed angiographically in 610 patients and a potential association with the result of an intracoronary acetylcholine (ACh) provocation test was investigated.
RESULTS
The comparison showed that angiographic morphologic variations in the coronary arteries are related to the occurrence of coronary spasm. We observed a strong association between the presence of epicardial atherosclerosis and epicardial spasm [87 patients of 179 with epicardial spasm had epicardial atherosclerosis (49%) vs. 45 patients of 172 with microvascular spasm (26%) vs. 89 patients of 259 with negative/inconclusive ACh test (36%); P < 0.005]. Moreover, we found a higher frequency of coronary tortuosity in patients with microvascular spasm [99 patients of 172 with microvascular spasm had at least moderate coronary tortuosity (58%) vs. 76 patients of 179 with epicardial spasm (43%) vs. 126 patients of 259 with negative/inconclusive ACh test (49%); P = 0.017]. Multivariable analysis revealed epicardial atherosclerosis (<50% stenosis) on coronary angiography as a predictor for epicardial spasm (OR, 2.096; 95% CI, 1.467-2.995; P < 0.0005). Female sex (OR, 5.469; 95% CI, 3.433-8.713; P < 0.0005), and exertional angina (OR, 2.411; 95% CI, 1.597-3.639; P < 0.0005) were predictors of microvascular spasm in multivariable analysis.
CONCLUSION
In angina patients with no obstructive coronary artery disease, epicardial atherosclerosis is associated with ACh-induced epicardial coronary spasm. Moreover, coronary microvascular spasm is more prevalent in female patients and those with exertional angina. Our results provide insights into the relationship between coronary morphology and coronary vasomotor function.
Identifiants
pubmed: 36484218
doi: 10.1097/MCA.0000000000001196
pii: 00019501-202301000-00005
doi:
Substances chimiques
Acetylcholine
N9YNS0M02X
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
34-41Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, et al. Coronary Vasomotion Disorders International Study Group. The who, what, why, when, how and where of vasospastic angina. Circ J 2016; 80:289–298.
Ong P, Athanasiadis A, Sechtem U. Gender aspects in patients with angina and unobstructed coronary arteries. Clin Res Cardiol Suppl 2013; 8:25–31.
Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AH, et al. An EAPCI expert consensus document on ischaemia with non-obstructive coronary arteries in collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J 2020; 41:3504–3520.
Saraste A, Knuuti J, Knuuti J. ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes: recommendations for cardiovascular imaging. Herz 2020; 45:409–420.
Okumura K, Yasue H, Matsuyama K, Goto K, Miyag H, Ogawa H, et al. Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm. J Am Coll Cardiol 1988; 12:883–888.
Hung M-J, Hu P, Hung M-Y. Coronary artery spasm: review and update. Int J Med Sci 2014; 11:1161–1171.
Beltrame JF. The emergence of the coronary vasomotor dysfunction era. Int J Cardiol 2018; 254:43–44.
Ong P, Athanasiadis A, Perne A, Mahrholdt H, Schäufele T, Hill S, et al. Coronary vasomotor abnormalities in patients with stable angina after successful stent implantation but without in-stent restenosis. Clin Res Cardiol 2014; 103:11–19.
Münzel T. Endotheliale dysfunktion: pathophysiologie, diagnostik und prognostische bedeutung. DMW Dtsch Med Wochenschr 2008; 133:2465–2470.
Schächinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000; 101:1899–1906.
Ong P, Athanasiadis A, Sechtem U. Intracoronary acetylcholine provocation testing for assessment of coronary vasomotor disorders. J Visualized Exp 2016; (114):54295.
Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, et al.; Coronary Vasomotion Disorders International Study Group. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J 2017; 38:2565–2568.
Eleid MF, Guddeti RR, Tweet MS, Lerman A, Singh M, Best PJ, et al. Coronary artery tortuosity in spontaneous coronary artery dissection: angiographic characteristics and clinical implications. Circ Cardiovasc Interventions 2014; 7:656–662.
Bairey Merz CN, Pepine CJ, Walsh MN, Fleg JL, Camici PG, Chilian WM, et al. Ischemia and no obstructive coronary artery disease (INOCA) developing evidence-based therapies and research agenda for the next decade. Circulation 2017; 135:1075–1092.
Ford TJ, Stanley B, Sidik N, Good R, Rocchiccioli P, McEntegart M, et al. 1-year outcomes of angina management guided by invasive coronary function testing (CorMicA). Cardiovasc Interv 2020; 13:33–45.
Ford TJ, Yii E, Sidik N, Good R, Rocchiccioli P, McEntegart M, et al. Ischemia and no obstructive coronary artery disease: prevalence and correlates of coronary vasomotion disorders. Circ Cardiovasc Interv 2019; 12:e008126.
Shimokawa H, Tomoike H, Nabeyama S, Yamamoto H, Ishii Y, Tanaka K, et al. Coronary artery spasm induced in miniature swine: angiographic evidence and relation to coronary atherosclerosis. Am Heart J 1985; 110:300–310.
Tiwari S, Zhang Y, Heller J, Abernethy DR, Soldatov NM. Atherosclerosis-related molecular alteration of the human CaV1. 2 calcium channel α1C subunit. Proc Natl Acad Sci USA 2006; 103:17024–17029.
Pellegrini D, Konst R, van den Oord S, Dimitriu-Leen A, Mol JQ, Jansen T, et al. Features of atherosclerosis in patients with angina and no obstructive coronary artery disease. Eurointervention 2022; 18:e397–e404.
Zegers ES, Meursing BTJ, Zegers EB, Ophuis AOM. Coronary tortuosity: a long and winding road. Netherlands Heart J 2007; 15:191–195.
Gaibazzi N. Less than straight anginal symptoms. Int J Cardiol 2011; 148:385–386.
Gaibazzi N, Rigo F, Reverberi C. Severe coronary tortuosity or myocardial bridging in patients with chest pain, normal coronary arteries, and reversible myocardial perfusion defects. Am J Cardiol 2011; 108:973–978.
Dobrin PB, Schwarcz TH, Baker WH. Mechanisms of arterial and aneurysmal tortuosity. Surgery 1988; 104:568–571.
Li Y, Shen C, Ji Y, Feng Y, Ma G, Liu N. Clinical implication of coronary tortuosity in patients with coronary artery disease. PLoS One 2011; 6:e24232.
Chiha J, Mitchell P, Gopinath B, Burlutsky G, Kovoor P, Thiagalingam A. Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease. IJC Heart Vasc 2017; 14:23–27.
Masumoto A, Mohri M, Takeshita A. Three-year follow-up of the Japanese patients with microvascular angina attributable to coronary microvascular spasm. Int J Cardiol 2001; 81:151–156.
Jansen TPJ, van Keeken K, Konst RE, Dimitriu-Leen A, Maas AHEM, van Royen N, et al. Relation between coronary tortuosity and vasomotor dysfunction in patients without obstructed coronaries? Front Cardiovasc Med 2022; 8:804731.
Mohri M, Koyanagi M, Egashira K, Tagawa H, Ichiki T, Shimokawa H, et al. Angina pectoris caused by coronary microvascular spasm. Lancet 1998; 351:1165–1169.
Rahman H, Ryan M, Lumley M, Modi B, McConkey H, Ellis H, et al. Coronary microvascular dysfunction is associated with myocardial ischemia and abnormal coronary perfusion during exercise. Circulation 2019; 140:1805–1816.
Ong P, Safdar B, Seitz A, Hubert A, Beltrame JF, Prescott E. Diagnosis of coronary microvascular dysfunction in the clinic. Cardiovasc Res 2020; 116:841–855.