Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries

被引:46
作者
Montone, Rocco Antonio [1 ]
Niccoli, Giampaolo [1 ,2 ]
Russo, Michele [2 ]
Giaccari, Marta [2 ]
Del Buono, Marco Giuseppe [2 ]
Meucci, Maria Chiara [2 ]
Gurguglione, Filippo [2 ]
Vergallo, Rocco [2 ]
D'Amario, Domenico [1 ]
Buffon, Antonino [1 ,2 ]
Leone, Antonio M. [1 ]
Burzotta, Francesco [1 ,2 ]
Aurigemma, Cristina [1 ]
Trani, Carlo [1 ,2 ]
Liuzzo, Giovanna [1 ,2 ]
Lanza, Gaetano A. [1 ,2 ]
Crea, Filippo [1 ,2 ]
机构
[1] Fdn Policlin Univ A Gemelli IRCCS, Dept Cardiovasc & Thorac Sci, Lgo A Gemelli 1, I-00168 Rome, Italy
[2] Univ Cattolica Sacro Cuore, Rome, Italy
关键词
Epicardial spasm; MINOCA; Microvascular spasm; Provocative test; INTERNATIONAL STANDARDIZATION; DIAGNOSTIC-CRITERIA; FOCAL VASOSPASM; DYSFUNCTION; ANGINA; ASSOCIATION; VASOMOTION; INSIGHTS; RISK;
D O I
10.1007/s00392-019-01523-w
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Coronary vasomotor dysfunction represents an important mechanism responsible for myocardial ischaemia in patients with non-obstructive coronary artery disease (CAD). The use of invasive provocative tests allows identifying patients with epicardial or microvascular spasm. Of note, clinical characteristics associated with the occurrence of epicardial or microvascular spasm have still not completely clarified. Methods and results We prospectively enrolled consecutive patients undergoing coronary angiography for suspected myocardial ischaemia/necrosis with evidence of non-obstructive CAD and undergoing intracoronary provocative test for suspected vasomotor dysfunction. Patients with a positive provocative test were enrolled. Clinical, echocardiographic and angiographic characteristics of patients were evaluated according to the pattern of vasomotor dysfunction (epicardial vs. microvascular spasm). We included 120 patients [68 patients with stable angina and 52 patients with myocardial infarction and non-obstructive coronary arteries (MINOCA)]. In particular, 77 (64.2%) patients had a provocative test positive for epicardial spasm and 43 (35.8%) patients for microvascular spasm. Patients with epicardial spasm were more frequently males, smokers, had higher rates of diffuse coronary atherosclerosis at angiography and more frequently presented with MINOCA. On the other hand, patients with microvascular spasm presented more frequently diastolic dysfunction. At multivariate logistic regression analysis male sex, smoking, and diffuse coronary atherosclerosis were independent predictors for the occurrence of epicardial spasm. Conclusions Our study showed that specific clinical features are associated with different responses to intracoronary provocative test. Epicardial spasm is more frequent in males and in MINOCA patients, whereas microvascular spasm is more frequent in patients with stable angina and is associated with diastolic dysfunction.
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收藏
页码:435 / 443
页数:9
相关论文
共 35 条
[1]   Sex-Related Differences in Vasomotor Function in Patients With Angina and Unobstructed Coronary Arteries [J].
Aziz, Ahmed ;
Hansen, Henrik Steen ;
Sechtem, Udo ;
Prescott, Eva ;
Ong, Peter .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2017, 70 (19) :2349-2358
[2]   International standardization of diagnostic criteria for vasospastic angina [J].
Beltrame, John F. ;
Crea, Filippo ;
Kaski, Juan Carlos ;
Ogawa, Hisao ;
Ong, Peter ;
Sechtem, Udo ;
Shimokawa, Hiroaki ;
Merz, C. Noel Bairey .
EUROPEAN HEART JOURNAL, 2017, 38 (33) :2565-2568
[3]   Stress T1-mapping cardiovascular magnetic resonance imaging and inducible myocardial ischemia [J].
Bohnen, Sebastian ;
Pruessner, Lennard ;
Vettorazzi, E. ;
Radunski, Ulf K. ;
Tahir, Enver ;
Schneider, Jan ;
Cavus, Ersin ;
Avanesov, Maxim ;
Stehning, Christian ;
Adam, Gerhard ;
Blankenberg, Stefan ;
Lund, Gunnar K. ;
Muellerleile, Kai .
CLINICAL RESEARCH IN CARDIOLOGY, 2019, 108 (08) :909-920
[4]   Angina with "normal" coronary arteries a changing philosophy [J].
Bugiardini, R ;
Merz, CNB .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 293 (04) :477-484
[5]   Medical progress - Coronary microvascular dysfunction [J].
Camici, Paolo G. ;
Crea, Filippo .
NEW ENGLAND JOURNAL OF MEDICINE, 2007, 356 (08) :830-840
[6]   The parallel tales of microvascular angina and heart failure with preserved ejection fraction: a paradigm shift [J].
Crea, Filippo ;
Merz, C. Noel Bairey ;
Beltrame, John F. ;
Kaski, Juan Carlos ;
Ogawa, Hisao ;
Ong, Peter ;
Sechtem, Udo ;
Shimokawa, Hiroaki ;
Camici, Paolo G. .
EUROPEAN HEART JOURNAL, 2017, 38 (07) :473-477
[7]   Coronary microvascular dysfunction: an update [J].
Crea, Filippo ;
Camici, Paolo G. ;
Merz, Cathleen Noel Bairey .
EUROPEAN HEART JOURNAL, 2014, 35 (17) :1101-+
[8]   Coronary microvascular dysfunction in patients with acute coronary syndrome and no obstructive coronary artery disease [J].
De Vita, Antonio ;
Manfredonia, Laura ;
Lamendola, Priscilla ;
Villano, Angelo ;
Ravenna, Salvatore Emanuele ;
Bisignani, Antonio ;
Niccoli, Giampaolo ;
Lanza, Gaetano Antonio ;
Crea, Filippo .
CLINICAL RESEARCH IN CARDIOLOGY, 2019, 108 (12) :1364-1370
[9]   Sex differences in cardiovascular disease - Impact on care and outcomes [J].
Humphries, K. H. ;
Izadnegandar, M. ;
Sedlak, T. ;
Saw, J. ;
Johnston, N. ;
Schenck-Gustafsson, K. ;
Shah, R. U. ;
Regitz-Zagrosek, V. ;
Grewal, J. ;
Vaccarino, V. ;
Wei, J. ;
Merz, C. N. Bairey .
FRONTIERS IN NEUROENDOCRINOLOGY, 2017, 46 :46-70
[10]   Reappraisal of Ischemic Heart Disease: Fundamental Role of Coronary Microvascular Dysfunction in the Pathogenesis of Angina Pectoris [J].
Kaski, Juan-Carlos ;
Crea, Filippo ;
Gersh, Bernard J. ;
Camici, Paolo G. .
CIRCULATION, 2018, 138 (14) :1463-1480