Mineo Takashi, Usui Eisuke, Kanaji Yoshihisa, Hada Masahiro, Nagamine Tatsuhiro, Ueno Hiroki, Nogami Kai, Setoguchi Mirei, Tahara Tomohiro, Sakamoto Tatsuya, Hoshino Masahiro, Sugiyama Tomoyo, Yonetsu Taishi, Sasano Tetsuo, Kakuta Tsunekazu
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan (T.M., E.U., Y.K., M. Hada, T.N., H.U., K.N., M.S., T.T., T. Sakamoto, M. Hoshino, T.Y., T.K.).
Department of Cardiovascular Medicine, Institute of Science Tokyo, Japan (T. Sugiyama, T. Sasano).
Circ Cardiovasc Imaging. 2025 Apr;18(4):e017565. doi: 10.1161/CIRCIMAGING.124.017565. Epub 2025 Mar 21.
Recent studies have shown that vasospastic angina (VSA) is associated with myocardial bridge (MB) and pericoronary adipose tissue inflammation. We aimed to investigate the clinical and coronary computed tomography angiographic (CCTA) features that could predict VSA in patients with angina and nonobstructive coronary arteries.
We retrospectively studied patients with angina and nonobstructive coronary arteries who underwent a spasm provocation test and CCTA within 3 months before the spasm provocation test. Pericoronary adipose tissue inflammation was evaluated using the fat attenuation index (FAI) of the proximal reference diameter and the inner 2 mm adipose tissue layer (FAI) from the vessel wall. Coronary plaques were qualitatively classified as noncalcified or calcified plaques in each vessel. In addition, MB was evaluated in the left anterior descending artery.
This study included 142 patients, with 55 (38.7%) diagnosed with VSA. Factors associated with VSA included male sex (74.5% versus 51.7%, =0.01), smoking history (70.9% versus 52.9%, =0.05), CCTA-defined MB (49.1% versus 28.7%, =0.02), and FAI, especially FAI in the right coronary artery-FAI (-68.8 Hounsfield unit versus -74.0 Hounsfield unit, <0.01), as well as the presence of CCTA-defined mixed or noncalcified plaque anywhere in the coronary tree (65.5% versus 39.1%, <0.01). In a multivariable analysis, CCTA-defined MB (odds ratio, 2.23 [95% CI, 1.03-4.83]; =0.04), right coronary artery-FAI (odds ratio, 1.07 [95% CI, 1.02-1.12]; <0.01), and the presence of mixed or noncalcified plaque (odds ratio, 3.15 [95% CI, 1.45-6.80]; <0.01) were independently associated with VSA. A combination of CCTA-defined MB in the left descending artery, high right coronary artery-FAI (≥-72.6 Hounsfield unit, median), and CCTA-defined mixed or noncalcified plaque in the coronary tree predicted VSA with a 75.0% probability, while the absence of all 3 factors precluded VSA with 95.6% probability.
For patients with angina and nonobstructive coronary arteries, a prespasm provocation test using a noninvasive comprehensive assessment with CCTA may help identify those at high risk for VSA.
最近的研究表明，血管痉挛性心绞痛（VSA）与心肌桥（MB）和冠状动脉周围脂肪组织炎症有关。我们旨在研究可预测心绞痛和非阻塞性冠状动脉患者发生VSA的临床和冠状动脉计算机断层扫描血管造影（CCTA）特征。
我们回顾性研究了在痉挛激发试验前3个月内接受痉挛激发试验和CCTA的心绞痛和非阻塞性冠状动脉患者。使用近端参考直径的脂肪衰减指数（FAI）和血管壁内2mm脂肪组织层（FAI）评估冠状动脉周围脂肪组织炎症。对每条血管中的冠状动脉斑块进行定性分类为非钙化或钙化斑块。此外，对左前降支进行心肌桥评估。
本研究纳入142例患者，其中55例（38.7%）诊断为VSA。与VSA相关的因素包括男性（74.5%对51.7%，P=0.01）、吸烟史（70.9%对52.9%，P=0.05）、CCTA定义的心肌桥（49.1%对28.7%，P=0.02）和FAI，尤其是右冠状动脉-FAI（-68.8亨氏单位对-74.0亨氏单位，P<0.01），以及冠状动脉树中任何部位存在CCTA定义的混合或非钙化斑块（65.5%对39.1%，P<0.01）。在多变量分析中，CCTA定义的心肌桥（比值比，2.23[95%CI，1.03-4.83]；P=0.04）、右冠状动脉-FAI（比值比，1.07[95%CI，1.02-1.12]；P<0.01）和混合或非钙化斑块的存在（比值比，3.15[95%CI，1.45-6.80]；P<0.01）与VSA独立相关。左降支中CCTA定义的心肌桥、高右冠状动脉-FAI（≥-72.6亨氏单位，中位数）和冠状动脉树中CCTA定义的混合或非钙化斑块的组合预测VSA的概率为75.0%，而不存在所有这3个因素可排除VSA的概率为95.6%。
对于心绞痛和非阻塞性冠状动脉患者，在痉挛激发试验前使用CCTA进行无创综合评估可能有助于识别VSA高危患者。
