Watanabe Takahiro, Kanaji Yoshihisa, Usui Eisuke, Hada Masahiro, Nagamine Tatsuhiro, Ueno Hiroki, Setoguchi Mirei, Sayama Kodai, Shimosato Hikaru, Kakuta Tsunekazu
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
JACC Case Rep. 2025 May 7;30(9):103304. doi: 10.1016/j.jaccas.2025.103304. Epub 2025 Apr 9.
A 71-year-old woman presented with rest angina. A spasm provocation test (SPT) using acetylcholine (Ach) confirmed epicardial coronary vasospasm in the left anterior descending artery (LAD) and coronary microvascular spasm (MVS) in the right coronary artery (RCA), according to current guidelines. After nitrate administration, coronary function tests (CFTs) with adenosine were conducted on the RCA at 30-minute intervals, demonstrating significant improvement in coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). This case was first diagnosed as vasospastic angina (VSA) involving the LAD, MVS in the RCA, normal coronary function in the LAD, and coronary microvascular dysfunction (CMD) in the RCA, highlighting regional differences in vascular reactivity and microvascular function in the same patients. The improvement in CFR and IMR during the second CFT suggests longer persistence of MVS, indicating that post-SPT functional testing may overestimate microvascular dysfunction due to lingering MVS, even after nitrate administration.
一名71岁女性因静息性心绞痛就诊。根据现行指南，使用乙酰胆碱（Ach）进行的痉挛激发试验（SPT）证实左前降支（LAD）存在心外膜冠状动脉痉挛，右冠状动脉（RCA）存在冠状动脉微血管痉挛（MVS）。给予硝酸盐后，每隔30分钟对RCA进行一次腺苷冠状动脉功能测试（CFT），结果显示冠状动脉血流储备（CFR）和微循环阻力指数（IMR）有显著改善。该病例最初被诊断为累及LAD的血管痉挛性心绞痛（VSA）、RCA的MVS、LAD冠状动脉功能正常以及RCA冠状动脉微血管功能障碍（CMD），突出了同一患者血管反应性和微血管功能的区域差异。第二次CFT期间CFR和IMR的改善表明MVS持续时间更长，这表明SPT后的功能测试可能会高估由于MVS持续存在导致的微血管功能障碍，即使在给予硝酸盐后也是如此。
