缺乏 I 类血管反应性测试来诊断冠状动脉痉挛患者。
Lack of Class I Vasoreactivity Testing for Diagnosing Patients With Coronary Artery Spasm.
机构信息
Department of Cardiology, Minami Matsuyama Hospital, Matsuyma City, Ehime, Japan.
Department of Cardiology, Ehime Prefectural Niihama Hospital, Niihama, Ehime, Japan.
出版信息
Clin Cardiol. 2024 Sep;47(9):e70004. doi: 10.1002/clc.70004.
BACKGROUND
Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS).
HYPOTHESIS
Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm.
METHODS
Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I.
RESULTS
There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent.
CONCLUSIONS
Cardiologists should understand the imperfection of these vasoreactivity tests when diagnosing patients with VSA.
背景
根据冠状动脉血管运动障碍国际研究（COVADIS）小组和日本循环学会（JCS）指南的建议，血管反应性测试（如冠状动脉内乙酰胆碱（ACh）或麦角新碱（EM））被定义为诊断血管痉挛性心绞痛（VSA）的 I 类标准。
假说
尽管血管反应性测试是一种临床有用的工具，但在诊断冠状动脉痉挛方面存在一些风险和局限性。
方法
从 I 类的角度总结了以前关于血管反应性测试诊断冠状动脉痉挛存在的报告。
结果
与日常痉挛相关的问题有几个，如可重复性、低估、高估和不确定/非特异性结果。由于冠状动脉内 ACh 引起的诱发痉挛并不总是与冠状动脉内 EM 引起的痉挛相似，可能是由于不同的介质，因此对于每个血管活性药物均未显示出诱发痉挛的情况下，为了诊断 VSA，心脏病专家有必要补充使用这些血管反应性测试。
结论
当诊断 VSA 患者时，心脏病专家应了解这些血管反应性测试的不完美之处。
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