Antonio Luis Arrebola-Moreno1, Juan Pedro Arrebola2, Antonio Moral-Ruiz3, Jose Antonio Ramirez-Hernandez4, Rafael Melgares-Moreno4, Juan Carlos Kaski5. 1. Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, UK. 2. Laboratorio de Investigaciones Médicas, Hospital Universitario San Cecilio, Universidad de Granada, Granada, Spain. 3. Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain. 4. Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain. 5. Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain. Electronic address: jkaski@sgul.ac.uk.
Abstract
AIMS: Impaired coronary microvascular dilatory function can lead to exercise induced myocardial ischemia and angina pectoris even in patients without significant (>50%) obstructive coronary atherosclerosis (APWOCA). Diffuse distal vessel epicardial spasm and microvascular spasm have been also proposed as a plausible explanation for angina at rest in these patients. However, objective systematic evidence for the latter i.e. echocardiographic wall motion abnormalities during angina, is lacking at present. Coronary epicardial and microvascular spasm can be triggered in susceptible patients by the administration of intracoronary acetylcholine (Ach). We sought to assess whether Ach induced diffuse distal epicardial coronary artery spasm (≥75% diameter reduction) and coronary microvascular spasm can cause transient ischemic left ventricular dysfunction, as assessed by echocardiography. METHODS: 50 patients (19 men aged 60.5 ± 8.9 years) with stable APWOCA were assessed for coronary spasm and myocardial ischemia with intracoronary Ach infusion, 2D transthoracic echocardiography (before and during Ach testing), continuous 12-lead ECG monitoring, and ultrasensitive cardiac troponin (US-cTn) measurement before and within 4 h after Ach testing. RESULTS: 14 patients (28%) had a "negative" Ach test, 14 (28%) developed coronary microvascular spasm and 17 (34%) had diffuse distal epicardial spasm. In 5 patients (10%) the test was inconclusive. Echocardiographic variables including deceleration time, EF slope and E/A, as well as ultrasensitive-cTn concentrations were abnormal during Ach induced ischemic ECG changes. CONCLUSIONS: We have, for the first time, demonstrated that Ach induced coronary microvascular spasm is associated with echocardiographic changes and ultrasensitive-cTn elevations, indicative of myocardial ischemia.
AIMS: Impaired coronary microvascular dilatory function can lead to exercise induced myocardial ischemia and angina pectoris even in patients without significant (>50%) obstructive coronary atherosclerosis (APWOCA). Diffuse distal vessel epicardial spasm and microvascular spasm have been also proposed as a plausible explanation for angina at rest in these patients. However, objective systematic evidence for the latter i.e. echocardiographic wall motion abnormalities during angina, is lacking at present. Coronary epicardial and microvascular spasm can be triggered in susceptible patients by the administration of intracoronary acetylcholine (Ach). We sought to assess whether Ach induced diffuse distal epicardial coronary artery spasm (≥75% diameter reduction) and coronary microvascular spasm can cause transient ischemic left ventricular dysfunction, as assessed by echocardiography. METHODS: 50 patients (19 men aged 60.5 ± 8.9 years) with stable APWOCA were assessed for coronary spasm and myocardial ischemia with intracoronary Ach infusion, 2D transthoracic echocardiography (before and during Ach testing), continuous 12-lead ECG monitoring, and ultrasensitive cardiac troponin (US-cTn) measurement before and within 4 h after Ach testing. RESULTS: 14 patients (28%) had a "negative" Ach test, 14 (28%) developed coronary microvascular spasm and 17 (34%) had diffuse distal epicardial spasm. In 5 patients (10%) the test was inconclusive. Echocardiographic variables including deceleration time, EF slope and E/A, as well as ultrasensitive-cTn concentrations were abnormal during Ach induced ischemic ECG changes. CONCLUSIONS: We have, for the first time, demonstrated that Ach induced coronary microvascular spasm is associated with echocardiographic changes and ultrasensitive-cTn elevations, indicative of myocardial ischemia.
Authors: Rocco Antonio Montone; Giampaolo Niccoli; Michele Russo; Marta Giaccari; Marco Giuseppe Del Buono; Maria Chiara Meucci; Filippo Gurguglione; Rocco Vergallo; Domenico D'Amario; Antonino Buffon; Antonio M Leone; Francesco Burzotta; Cristina Aurigemma; Carlo Trani; Giovanna Liuzzo; Gaetano A Lanza; Filippo Crea Journal: Clin Res Cardiol Date: 2019-07-03 Impact factor: 5.460
Authors: Odayme Quesada; Omeed Elboudwarej; Michael D Nelson; Ahmed Al-Badri; Mitra Mastali; Janet Wei; Bijan Zarrabi; Nissi Suppogu; Haider Aldiwani; Puja Mehta; Chrisandra Shufelt; Galen Cook-Wiens; Daniel S Berman; Louise E J Thomson; Eileen Handberg; Carl J Pepine; Jennifer E Van Eyk; C Noel Bairey Merz Journal: Am Heart J Plus Date: 2022-03-03