Huang Jingwen, Steinberg Rebecca, Brown Matthew J, Rinfret Stéphane, Toleva Olga
Department of Medicine, Emory University School of Medicine Atlanta, GA.
Department of Cardiology, Emory University School of Medicine Atlanta, GA.
US Cardiol. 2023 Jun 9;17:e07. doi: 10.15420/usc.2022.33. eCollection 2023.
Vasospastic angina (VSA) occurs at rest and on exertion, with transient electrocardiographic ischemic changes. VSA presents with spontaneous coronary artery spasm (CAS); it has been associated with stable angina, acute coronary syndromes, and sudden cardiac death. CAS can be identified in normal arteries or non-obstructive coronary atherosclerosis, but is also prevalent in patients with coronary artery disease. The diagnosis is made with invasive coronary reactivity testing with provocation using acetylcholine (Ach). Epicardial spasms can be visualized through coronary angiography as a reversible epicardial vessel narrowing, while the diagnosis of microvascular spasm can be made when angina symptoms and ECG changes happen following intracoronary Ach without epicardial spasm. Identification of CAS allows for risk stratification and specific therapies targeting endothelial dysfunction and paradoxical vascular smooth muscle cell constriction. Therapies include calcium channel blockers as monotherapy or in a combination of a dihydropyridine and non-dihydropyridine. Short-acting nitrates offer acute symptomatic relief but long-acting nitrates should be used sparingly. This current update on invasive evaluation of VSA discusses unified Ach protocols.
变异性心绞痛（VSA）在休息和运动时均可发生，并伴有短暂的心电图缺血性改变。VSA表现为自发性冠状动脉痉挛（CAS）；它与稳定型心绞痛、急性冠状动脉综合征及心源性猝死相关。CAS可在正常动脉或非阻塞性冠状动脉粥样硬化中发现，但在冠状动脉疾病患者中也很常见。诊断通过使用乙酰胆碱（Ach）激发的有创冠状动脉反应性测试来进行。心外膜痉挛可通过冠状动脉造影显示为可逆的心外膜血管狭窄，而当心绞痛症状和心电图改变在冠状动脉内注射Ach后发生且无心外膜痉挛时，则可诊断为微血管痉挛。CAS的识别有助于进行风险分层以及针对内皮功能障碍和矛盾的血管平滑肌细胞收缩的特异性治疗。治疗方法包括单用钙通道阻滞剂或联合使用二氢吡啶类和非二氢吡啶类药物。短效硝酸盐可提供急性症状缓解，但长效硝酸盐应谨慎使用。本次关于VSA有创评估的更新讨论了统一的Ach方案。
