BACKGROUND: Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary stenosis, in whom coronary functional abnormalities could be involved. OBJECTIVES: This study examined the significance of coronary functional abnormalities in a comprehensive manner for both epicardial and microvascular coronary arteries in patients with angina and nonobstructive coronary artery disease (CAD). METHODS: This study prospectively enrolled 187 consecutive patients (male/female 113/74, 63.2 ± 12.3 years), who underwent acetylcholine provocation test for coronary spasm and measurement of index of microcirculatory resistance (IMR) to evaluate coronary microvascular function, and followed them for a median of 893 days. RESULTS: Of all subjects, acetylcholine test identified 128 patients with vasospastic angina (VSA) (68%), and cardiac events occurred in 10 patients (5.3%) during the follow-up. Multivariable analysis revealed that IMR correlated with the incidence of cardiac events (hazard ratio: 1.05; 95% confidence interval: 1.02 to 1.09; p = 0.002) and receiver-operating characteristics (ROC) curve analysis identified IMR of 18.0 as the optimal cut-off value. Among the 4 groups based on the cut-off value of IMR and the presence of VSA, the Kaplan-Meier survival analysis showed a significantly worse prognosis in the group with high IMR (≥18.0) and VSA compared with other groups (log rank, p = 0.002). Importantly, intracoronary administration of fasudil, a Rho-kinase inhibitor, significantly ameliorated IMR in the VSA patients with increased IMR (p < 0.0001). CONCLUSIONS: These results indicate that in patients with angina and nonobstructive CAD, coexistence of epicardial coronary spasm and increased microvascular resistance is associated with worse prognosis, for which Rho-kinase activation may be involved.
BACKGROUND: Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary stenosis, in whom coronary functional abnormalities could be involved. OBJECTIVES: This study examined the significance of coronary functional abnormalities in a comprehensive manner for both epicardial and microvascular coronary arteries in patients with angina and nonobstructive coronary artery disease (CAD). METHODS: This study prospectively enrolled 187 consecutive patients (male/female 113/74, 63.2 ± 12.3 years), who underwent acetylcholine provocation test for coronary spasm and measurement of index of microcirculatory resistance (IMR) to evaluate coronary microvascular function, and followed them for a median of 893 days. RESULTS: Of all subjects, acetylcholine test identified 128 patients with vasospastic angina (VSA) (68%), and cardiac events occurred in 10 patients (5.3%) during the follow-up. Multivariable analysis revealed that IMR correlated with the incidence of cardiac events (hazard ratio: 1.05; 95% confidence interval: 1.02 to 1.09; p = 0.002) and receiver-operating characteristics (ROC) curve analysis identified IMR of 18.0 as the optimal cut-off value. Among the 4 groups based on the cut-off value of IMR and the presence of VSA, the Kaplan-Meier survival analysis showed a significantly worse prognosis in the group with high IMR (≥18.0) and VSA compared with other groups (log rank, p = 0.002). Importantly, intracoronary administration of fasudil, a Rho-kinase inhibitor, significantly ameliorated IMR in the VSApatients with increased IMR (p < 0.0001). CONCLUSIONS: These results indicate that in patients with angina and nonobstructive CAD, coexistence of epicardial coronary spasm and increased microvascular resistance is associated with worse prognosis, for which Rho-kinase activation may be involved.
Authors: Vijay Kunadian; Alaide Chieffo; Paolo G Camici; Colin Berry; Javier Escaned; Angela H E M Maas; Eva Prescott; Nicole Karam; Yolande Appelman; Chiara Fraccaro; Gill Louise Buchanan; Stephane Manzo-Silberman; Rasha Al-Lamee; Evelyn Regar; Alexandra Lansky; J Dawn Abbott; Lina Badimon; Dirk J Duncker; Roxana Mehran; Davide Capodanno; Andreas Baumbach Journal: Eur Heart J Date: 2020-10-01 Impact factor: 29.983
Authors: Harmony R Reynolds; C Noel Bairey Merz; Colin Berry; Rohit Samuel; Jacqueline Saw; Nathaniel R Smilowitz; Ana Carolina do A H de Souza; Robert Sykes; Viviany R Taqueti; Janet Wei Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Vincent Ngo; Anahita Tavoosi; Alexandre Natalis; Francois Harel; E Marc Jolicoeur; Robert S B Beanlands; Matthieu Pelletier-Galarneau Journal: J Nucl Cardiol Date: 2022-03-23 Impact factor: 5.952
Authors: Sascha Beck; Valeria Martínez Pereyra; Andreas Seitz; Johanna McChord; Astrid Hubert; Raffi Bekeredjian; Udo Sechtem; Peter Ong Journal: Eur Cardiol Date: 2021-07-05