Ozaki Y, Keane D, Serruys P W
Department of Interventional Cardiology, Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
J Am Coll Cardiol. 1995 Dec;26(7):1606-14. doi: 10.1016/0735-1097(95)00398-3.
This study sought to determine whether the location of coronary spastic activity may change over time in patients with persistent variant angina.
Although electrocardiographic studies have provided indirect evidence to indicate that the location of ischemia may change in patients with variant angina, it has not been tested by quantitative angiography whether the location of vasospastic activity may change over time.
Paired ergonovine provocation tests and coronary angiography were performed at a mean (+/- SD) interval of 43 +/- 13 months apart in patients with persistent symptoms of vasospastic angina in the absence of significant atherosclerosis. A total of 87 spastic and nonspastic segments of 87 major vessels in 29 patients were analyzed by quantitative angiography at baseline, after the administration of ergonovine and after isosorbide dinitrate at the initial and follow-up tests.
In 13 patients (group 1), coronary spasm was observed in the same 16 coronary segments at both the initial and follow-up ergonovine provocation tests. In 16 patients (group 2), the following angiographic changes occurred between the initial and follow-up tests in 48 major vessels: Of the 23 segments that developed spasm at the initial test, 10 did not have spasm at the follow-up test; of the 25 vessels that did not demonstrate spasm on the initial test, 12 demonstrated spasm on the follow-up test (a new site of spasm). Thus, in 22 (46%) of 48 vessels, fluctuation of spastic location was observed at follow-up.
Quantitative coronary angiography and repeated ergonovine tests revealed that some patients with persistent vasospastic angina demonstrate fluctuation of vasospastic location, whereas others exhibit a fixed location of vasospasm. Vasospastic angina may not only be a transient disease restricted in location, but may also be a persistent and variable condition involving multiple vessels over many years.
本研究旨在确定持续性变异型心绞痛患者冠状动脉痉挛活动的部位是否会随时间变化。
尽管心电图研究提供了间接证据表明变异型心绞痛患者缺血部位可能会发生变化，但血管痉挛活动部位是否会随时间变化尚未通过定量血管造影进行检验。
对无明显动脉粥样硬化的持续性血管痉挛性心绞痛症状患者，平均间隔43±13个月进行配对麦角新碱激发试验和冠状动脉造影。在基线、麦角新碱给药后以及初始和随访试验中硝酸异山梨酯给药后，对29例患者87条主要血管的87个痉挛和非痉挛节段进行定量血管造影分析。
13例患者（第1组）在初始和随访麦角新碱激发试验中，在相同的16个冠状动脉节段观察到冠状动脉痉挛。16例患者（第2组）在48条主要血管的初始和随访试验之间发生了以下血管造影变化：初始试验时出现痉挛的23个节段中，10个在随访试验中未出现痉挛；初始试验时未显示痉挛的25条血管中，12条在随访试验中出现痉挛（新的痉挛部位）。因此，在48条血管中的22条（46%）在随访时观察到痉挛部位的波动。
定量冠状动脉造影和重复麦角新碱试验显示，一些持续性血管痉挛性心绞痛患者表现出血管痉挛部位的波动，而另一些患者则表现出固定的血管痉挛部位。血管痉挛性心绞痛可能不仅是一种部位受限的短暂性疾病，还可能是一种多年来涉及多支血管的持续性和可变疾病。
