冠状动脉内压力变化是否有助于通过痉挛激发试验诊断冠状动脉痉挛？

Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test?

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. 2024 Jan 26;16(1):16-26. doi: 10.4330/wjc.v16.i1.16.

DOI:10.4330/wjc.v16.i1.16

PMID:38313387

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10835468/

Abstract

BACKGROUND

Although the spasm provocation test (SPT) can diagnose coronary spasms, it would be helpful if it could also predict their occurrence.

AIM

To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.

METHODS

Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure. During each SPT, the pressure wire was advanced into the distal portion of the right coronary artery (RCA) and left anterior descending coronary artery, and the ratio of intracoronary pressure to aortic pressure (Pd/Pa) was monitored. Coronary spasm was defined as an arterial narrowing of > 90% in response to the administration of acetylcholine (ACh), with chest symptoms and/or ischemic electrocardiographic changes. ACh was administered to the RCA at low, moderate, or high doses of 20, 50, or 80 µg, respectively, and to the left coronary artery (LCA) at low, moderate, or high doses of 50, 100, or 200 µg, respectively. Coronary arteries with coronary spasms at low doses of ACh were defined as group L, and those with coronary spasms at moderate or high doses were defined as group MH. Those who did not occur coronary spasms at any ACh dose were designated as group N.

RESULTS

Among the 132 coronary arteries assessed using a pressure wire, there were 49 in group N, 25 in group L, and 58 in group MH. Baseline Pd/Pa was the lowest in group L ( = 0.001). The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N ( < 0.001). A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95, with a sensitivity of 0.600 (15/25) and a specificity of 0.713 (76/107) and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was -0.04, with a sensitivity of 0.741 (43/58) and a specificity of 0.694 (34/49).

CONCLUSION

These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.

摘要

背景

尽管痉挛激发试验（SPT）可诊断冠状动脉痉挛，但如果它还能预测其发生情况则会很有帮助。

目的

研究在SPT期间使用压力导丝测量冠状动脉内压力的变化能否预测冠状动脉痉挛。

方法

70例患者接受了SPT并通过压力导丝测量冠状动脉内压力。在每次SPT期间，将压力导丝推进到右冠状动脉（RCA）和左前降支冠状动脉的远端，并监测冠状动脉内压力与主动脉压力之比（Pd/Pa）。冠状动脉痉挛定义为在给予乙酰胆碱（ACh）后动脉狭窄>90%，伴有胸部症状和/或缺血性心电图改变。分别以20、50或80μg的低、中、高剂量向RCA给予ACh，以50、100或200μg的低、中、高剂量向左冠状动脉（LCA）给予ACh。在低剂量ACh时发生冠状动脉痉挛的冠状动脉定义为L组，在中剂量或高剂量时发生冠状动脉痉挛的冠状动脉定义为MH组。在任何ACh剂量下均未发生冠状动脉痉挛的患者被指定为N组。

结果

在使用压力导丝评估的132条冠状动脉中，N组有49条，L组有25条，MH组有58条。L组的基线Pd/Pa最低（=0.001）。MH组从基线到低剂量ACh时Pd/Pa的下降低于N组（<0.001）。受试者操作特征分析表明，预测L组的截止基线Pd/Pa值为0.95，敏感性为0.600（15/25），特异性为0.713（76/107）；预测MH组从基线到低剂量ACh时Pd/Pa的截止值为-0.04，敏感性为0.741（43/58），特异性为0.694（34/49）。