Division of Cardiology, Kumamoto Central Hospital, Kumamoto, 1-5-1 Tainoshima, Kumamoto City 862-0965, Japan.
J Cardiol. 2009 Dec;54(3):512-5. doi: 10.1016/j.jjcc.2009.03.009. Epub 2009 May 21.
A 65-year-old man with advanced renal cell carcinoma was admitted due to continuing chest pain at rest. Two weeks before his admission, sorafenib had been started. He was diagnosed with non-ST-elevation myocardial infarction by laboratory data and electrocardiogram. Enhanced heart magnetic resonance imaging also showed subendocardial infarction. However, there was no stenosis in coronary arteries on angiography. Coronary artery spasm was induced by a provocative test. Cessation of sorafenib and administration of Ca-channel blocker and nitrates ameliorated his symptoms, but relapse occurred after resumption of sorafenib. Addition of oral nicorandil reduced his symptoms and maintained stable angina status. We report the first case of sorafenib-induced coronary artery spasm. Sorafenib is a multikinase inhibitor that targets signaling pathways necessary for cellular proliferation and survival. On the other hand, the Rho/ROCK pathway has an important role in the pathogenesis of coronary artery spasm. Our report may show an adverse effect on the Rho/ROCK pathway by sorafenib use.
一位 65 岁的老年男性患有晚期肾细胞癌，因持续性静息胸痛而入院。入院前两周开始使用索拉非尼。根据实验室数据和心电图检查，他被诊断为非 ST 段抬高型心肌梗死。增强心脏磁共振成像也显示心内膜下梗死。然而，血管造影显示冠状动脉无狭窄。冠状动脉痉挛通过激发试验诱发。停用索拉非尼，给予钙通道阻滞剂和硝酸盐可改善其症状，但在恢复索拉非尼后又复发。口服尼可地尔的加入减轻了他的症状，并保持稳定型心绞痛状态。我们报告了首例索拉非尼诱导的冠状动脉痉挛。索拉非尼是一种多激酶抑制剂，可靶向细胞增殖和存活所必需的信号通路。另一方面，Rho/ROCK 通路在冠状动脉痉挛的发病机制中起重要作用。我们的报告可能表明索拉非尼的使用对 Rho/ROCK 通路有不良影响。
