Jin Xuan, Kang Eun-Ju, Jin Cai-De, Lee Kwang-Min, Lim Kyung-Hee, Rha Seung-Woon, Choi Cheol-Ung, Yong Hwan-Seok, Yun Sung-Cheol, Budoff Matthew J, Yu Long-Hao, Kim Moo-Hyun
Department of Cardiology, Dong-A University Hospital, Busan 49201, Republic of Korea.
Department of Cardiology, Affiliated Hospital of Yanbian University, Yanji 133099, China.
J Clin Med. 2023 May 29;12(11):3753. doi: 10.3390/jcm12113753.
Vasospastic angina (VSA) is characterized by chest pain at rest with transient ischemic electrocardiographic changes in the ST segment, and a prompt response to nitrates. Vasospastic angina is among the most frequent of the coronary artery diseases in Asia, and coronary computed tomography angiography (CCTA) may become available as a non-invasive diagnosis method.
We prospectively enrolled 100 patients with suspected vasospastic angina at two centers from 2018 to 2020. All patients underwent baseline CCTA without a vasodilator in the early morning followed by catheterized coronary angiography and spasm testing. CCTA with intravenous infusion of nitrate (IV) was repeated within 2 weeks of baseline CCTA. Vasospastic angina as detected by CCTA was defined as significant stenosis (≥50%) with negative remodeling without definite plaques or diffuse small diameter (<2 mm) of a major coronary artery with a beaded appearance on baseline CT that completely dilated on IV nitrate CT. We analyzed diagnostic performance of dual-acquisition CCTA for the detection of vasospastic angina.
The patients were categorized into three groups according to their provocation test result (negative, = 36; probable positive, = 18; positive, = 31). The diagnostic accuracy in terms of CCTA per patient had a sensitivity of 55% (95% CI, 40-69), specificity of 89% (95% CI, 74-97), positive predictive value (PPV) of 87% (95% CI, 72-95), and negative predictive value (NPV) of 59% (95% CI, 51-67).
Dual-acquisition CCTA can support the non-invasive detection of vasospastic angina with relatively good specificity and PPV. CCTA was helpful for non-invasive screening of variant angina.
变异性心绞痛（VSA）的特征是静息时胸痛伴ST段短暂性缺血性心电图改变，对硝酸盐类药物迅速起效。变异性心绞痛是亚洲最常见的冠状动脉疾病之一，冠状动脉计算机断层扫描血管造影（CCTA）可能成为一种无创诊断方法。
我们在2018年至2020年期间在两个中心前瞻性纳入了100例疑似变异性心绞痛患者。所有患者均于清晨在未使用血管扩张剂的情况下接受基线CCTA检查，随后进行冠状动脉造影和痉挛试验。在基线CCTA检查后2周内重复进行静脉输注硝酸盐（IV）的CCTA检查。CCTA检测到的变异性心绞痛定义为主要冠状动脉存在显著狭窄（≥50%）且无明确斑块的负性重构或基线CT上呈串珠状外观的弥漫性小直径（<2 mm），在静脉注射硝酸盐CT上完全扩张。我们分析了双采CCTA对变异性心绞痛的诊断性能。
根据激发试验结果，患者被分为三组（阴性，=36；可能阳性，=18；阳性，=31）。每位患者CCTA的诊断准确性为敏感性55%（95%CI，40-69），特异性89%（95%CI，74-97），阳性预测值（PPV）87%（95%CI，72-95），阴性预测值（NPV）59%（95%CI，51-67）。
双采CCTA可支持以相对良好的特异性和PPV对变异性心绞痛进行无创检测。CCTA有助于对变异型心绞痛进行无创筛查。
