Ito Tsuyoshi, Fujita Hiroshi, Tani Tomomitsu, Sugiura Tomonori, Ohte Nobuyuki
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Int J Cardiol. 2015 Apr 1;184:475-480. doi: 10.1016/j.ijcard.2015.03.040. Epub 2015 Mar 4.
Coronary endothelial dysfunction is thought to underlie the development of coronary artery spasms. Malondialdehyde-modified low-density lipoprotein (MDA-LDL) was suggested as a marker of endothelial damage. This study investigated the diagnostic impact of MDA-LDL on ergonovine-induced coronary spasms.
We included 152 patients with suspected coronary spastic angina. MDA-LDL levels were measured before an ergonovine provocation test. Coronary spasm was defined as total or subtotal occlusion, compared to the relaxed state after nitroglycerin, associated with ischemic ECG changes and concurrent chest pain. Changes in vessel diameter in response to ergonovine were evaluated with quantitative coronary angiography.
Coronary spasms were observed in 41 patients (27%). MDA-LDL levels were significantly higher in patients with spasms compared to those without spasms (139.9 ± 45.9 U/L vs. 109.6 ± 36.6 U/L, p<0.01). Univariate logistic regression analyses indicated significant relationships between coronary spasms and MDA-LDL (per 10 U/L, odds ratio (OR): 1.20; p<0.01), high-density lipoprotein (per 10 mg/dL, OR: 0.76; p=0.03), smoking (OR: 3.04; p<0.01), and male gender (OR: 3.51; p<0.01). In the multivariate model, MDA-LDL (per 10 U/L, OR: 1.17; p<0.01) remained a significant predictor of coronary spasm. Regression analysis showed a positive correlation between MDA-LDL levels and coronary luminal diameter changes induced by ergonovine (r=0.57, p<0.01). The optimal MDA-LDL threshold for predicting coronary spasm was 121.3 U/L, identified with a receiver operating characteristic curve.
Increased circulating MDA-LDL levels were associated with ergonovine-induced coronary artery spasm.
冠状动脉内皮功能障碍被认为是冠状动脉痉挛发生的基础。丙二醛修饰的低密度脂蛋白（MDA-LDL）被认为是内皮损伤的标志物。本研究调查了MDA-LDL对麦角新碱诱发的冠状动脉痉挛的诊断影响。
我们纳入了152例疑似冠状动脉痉挛性心绞痛的患者。在麦角新碱激发试验前测量MDA-LDL水平。冠状动脉痉挛定义为与硝酸甘油后松弛状态相比的完全或次全闭塞，并伴有缺血性心电图改变和同时出现的胸痛。使用定量冠状动脉造影评估血管直径对麦角新碱的反应变化。
41例患者（27%）观察到冠状动脉痉挛。痉挛患者的MDA-LDL水平显著高于无痉挛患者（139.9±45.9 U/L对109.6±36.6 U/L，p<0.01）。单因素逻辑回归分析表明冠状动脉痉挛与MDA-LDL（每10 U/L，比值比（OR）：1.20；p<0.01）、高密度脂蛋白（每10 mg/dL，OR：0.76；p=0.03）、吸烟（OR：3.04；p<0.01）和男性（OR：3.51；p<0.01）之间存在显著关系。在多变量模型中，MDA-LDL（每10 U/L，OR：1.17；p<0.01）仍然是冠状动脉痉挛的显著预测因子。回归分析显示MDA-LDL水平与麦角新碱诱导的冠状动脉管腔直径变化之间存在正相关（r=0.57，p<0.01）。通过受试者工作特征曲线确定预测冠状动脉痉挛的最佳MDA-LDL阈值为121.3 U/L。
循环中MDA-LDL水平升高与麦角新碱诱导的冠状动脉痉挛相关。
