冠状动脉内压力在冠状动脉痉挛的两种类型（弥漫性或局灶性）之间是否存在差异？

Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

作者信息

Teragawa Hiroki, Oshita Chikage, Uchimura Yuko

机构信息

Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan.

出版信息

World J Cardiol. 2023 Jan 26;15(1):1-12. doi: 10.4330/wjc.v15.i1.1.

DOI:10.4330/wjc.v15.i1.1

PMID:36714369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9850670/

Abstract

BACKGROUND

Several reports show that two types of coronary vasospasm (diffuse and focal spasm) are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina (VSA). It is unclear whether intracoronary pressure differs between the two spasm types.

AIM

To investigate such relationships using a pressure wire during the spasm provocation test (SPT) in patients with VSA.

METHODS

Eighty-seven patients with VSA (average age: 67 years; 50 men, 37 women) underwent SPT. During the SPT, a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery, and the ratio of the intracoronary pressure to the aortic pressure (Pd/Pa) was continuously monitored. An SPT was performed using acetylcholine (ACh), and the presence of coronary spasm was defined as the presence of > 90% arterial narrowing in response to an ACh infusion, with the usual chest symptoms and/or ischemic ECG changes. Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification, while diffuse spasm was defined as > 90% spasm with two or more segments.

RESULTS

Among 87 patients, the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group ( = 33) than in the diffuse spasm group ( = 54, < 0.05). In the vessel analyses, in these 134 spastic segments, diffuse and focal spasms were detected in 100 and 34 vessels, respectively. The Pd/Pa at baseline was similar in both groups (diffuse: 0.96 ± 0.05, focal: 0.95 ± 0.05, = 0.35); however, the Pd/Pa during coronary spasm was lower in focal spastic vessels (0.66 ± 0.20) than in diffuse spastic vessels (0.76 ± 0.11, < 0.01), and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels (-0.29 ± 0.20) than in diffuse spastic vessels (-0.18 ± 0.11, < 0.01). The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.

CONCLUSION

These findings suggest that focal spasm may be more severe than diffuse spasm, judging from the intracoronary pressure during coronary spasm.

摘要

背景

多项报告显示，两种类型的冠状动脉痉挛（弥漫性和局灶性痉挛）与血管痉挛性心绞痛（VSA）患者冠状动脉痉挛的严重程度或预后相关。目前尚不清楚两种痉挛类型之间的冠状动脉内压力是否存在差异。

目的

在VSA患者的痉挛激发试验（SPT）期间使用压力导丝研究此类关系。

方法

87例VSA患者（平均年龄：67岁；男性50例，女性37例）接受了SPT。在SPT期间，将压力导丝推进到右冠状动脉和左前降支冠状动脉的远端，并持续监测冠状动脉内压力与主动脉压力之比（Pd/Pa）。使用乙酰胆碱（ACh）进行SPT，冠状动脉痉挛的存在定义为在注入ACh后出现>90%的动脉狭窄，并伴有常见的胸部症状和/或缺血性心电图改变。局灶性痉挛定义为美国心脏协会（AHA）分类中一个节段内的完全或次全痉挛，而弥漫性痉挛定义为两个或更多节段出现>90%的痉挛。

结果

在87例患者中，局灶性痉挛组（n = 33）代谢综合征和冠状动脉粥样硬化的发生率高于弥漫性痉挛组（n = 54，P < 0.05）。在血管分析中，在这134个痉挛节段中，分别在100支和34支血管中检测到弥漫性和局灶性痉挛。两组基线时的Pd/Pa相似（弥漫性：0.96±0.05，局灶性：0.95±0.05，P = 0.35）；然而，冠状动脉痉挛期间局灶性痉挛血管的Pd/Pa（0.66±0.20）低于弥漫性痉挛血管（0.76±0.11，P < 0.01），并且SPT期间局灶性痉挛血管的Pd/Pa降低幅度（-0.29±0.20）也低于弥漫性痉挛血管（-0.18±0.11，P < 0.01）。局灶性痉挛的存在是SPT期间Pd/Pa降低的一个重要因素。