Haze K, Sumiyoshi T, Fukami K, Ichida S, Saito M, Hiramori K
Jpn Circ J. 1985 Jan;49(1):82-93. doi: 10.1253/jcj.49.82.
We studied the clinical characteristics of 153 patients with angina pectoris associated with coronary artery spasm (CAS). The study was designed to investigate the relationship of CAS to ST segment deviation and to the site of fixed stenosis, and hemodynamic alteration during a spastic event. Analysis of coronary arteriograms and multilead electrocardiograms obtained simultaneously from 170 events of CAS by the use of radioluscent carbon-fiber electrodes resulted in 58 events with ST elevation which were related to total occlusion of major coronary arteries due to CAS; another 54 events with ST depression, in which the affected coronary arteries demonstrated severe but incomplete occlusion, or total occlusion but were visualized via collateral vessels; and remaining 58 events without ST deviation showing mild occlusion. The results indicate a close correlation between magnitude of CAS and ST segment deviation. CAS occurred at the site of pre-existing fixed stenosis including minor plaque defect in 133 patients and at apparently normal site in 20 patients. In the former group, only four patients had triple vessel disease, while 95 had nonsignificant fixed lesion. In the latter group, 10 patients had minor lesion distant from the site of CAS. Thus, CAS is closely related to fixed stenosis, which may have but a limited role as a cause of CAS. Hemodynamic measurements during spastic events were obtained from 49 patients including 41 events with spasm of the left anterior descending artery (LAD) and 21 events with spasm of the right coronary artery (RCA). The onset of an increase in left ventricular (LV) filling pressure and a reduction in LV dP/dt preceded ST segment deviation in all events. The first hemodynamic variable manifested in the spastic event was the reduction of LV contraction dP/dt in the majority of patients. The increase of LV filling pressure was greater in LAD spasm than RCA spasm (11 +/- 6 mmHg vs 7 +/- 4 mmHg, P less than 0.0125) and in events with ST elevation than with ST depression (11 +/- 5 mmHg vs 6 +/- 5 mmHg, p less than 0.001). Right ventricular functional impairment was mild in most patients during CAS. The study indicates that mechanical impairment precedes electrical impairment during CAS and that LAD spasm with ST elevation represents the most severe LV dysfunction.
我们研究了153例伴有冠状动脉痉挛（CAS）的心绞痛患者的临床特征。该研究旨在调查CAS与ST段偏移、固定狭窄部位的关系，以及痉挛发作时的血流动力学改变。通过使用放射性碳纤维电极，对170次CAS事件同时获得的冠状动脉造影和多导联心电图进行分析，结果显示58次事件出现ST段抬高，这与CAS导致的主要冠状动脉完全闭塞有关；另有54次事件出现ST段压低，其中受累冠状动脉表现为严重但不完全闭塞，或完全闭塞但通过侧支血管显影；其余58次事件无ST段偏移，显示轻度闭塞。结果表明CAS的程度与ST段偏移密切相关。CAS发生在133例患者已存在的固定狭窄部位，包括微小斑块缺损，20例发生在明显正常的部位。在前一组中，只有4例患者有三支血管病变，而95例有不显著的固定病变。在后一组中，10例患者有远离CAS部位的微小病变。因此，CAS与固定狭窄密切相关，固定狭窄作为CAS的原因可能作用有限。在49例患者中进行了痉挛发作时的血流动力学测量，包括41次左前降支（LAD）痉挛事件和21次右冠状动脉（RCA）痉挛事件。在所有事件中，左心室（LV）充盈压升高和LV dP/dt降低先于ST段偏移出现。痉挛发作时出现的第一个血流动力学变量在大多数患者中是LV收缩dP/dt降低。LAD痉挛时LV充盈压的升高大于RCA痉挛（11±6 mmHg对7±4 mmHg，P<0.0125），ST段抬高事件大于ST段压低事件（11±5 mmHg对6±5 mmHg，P<0.001）。在CAS期间，大多数患者右心室功能损害较轻。该研究表明，在CAS期间机械性损害先于电损害，且伴有ST段抬高的LAD痉挛代表最严重的LV功能障碍。
