Igarashi Y, Tamura Y, Tanabe Y, Fujita T, Tanaka Y, Yamazoe M, Shibata A
First Department of Internal Medicine, Niigata University School of Medicine, Japan.
Jpn Circ J. 1995 Feb;59(2):80-8. doi: 10.1253/jcj.59.80.
The relation between isolated negative U waves and the severity of induced coronary artery spasm was investigated in 24 patients with variant angina to determine the grade of myocardial ischemia during the appearance of isolated negative U waves. Coronary artery spasm was induced by injections of either incremental doses of acetylcholine or ergonovine into the left coronary artery. Coronary spasm was quantified into 4 grades: Grade 0 = complete perfusion, Grade 1 = partial perfusion, Grade 2 = penetration without perfusion, and Grade 3 = no perfusion. Induction with acetylcholine was discontinued when a coronary spasm of Grade > or = 2 was induced. Electrocardiogram in leads V1 to V6 and systemic blood pressure were recorded continuously. Provocations of coronary spasm with at least 2 doses of acetylcholine could be performed in 15 patients. All acetylcholine-induced coronary spasms of Grade < or = 1 disappeared spontaneously within 3 min. Negative U waves developed in 19 (79%) patients, in whom 37 trials with acetylcholine or ergonovine injection were performed. Isolated negative U waves were detected in 10 trials, negative U waves and ST depression in 8 trials, and negative U waves and ST elevation in 14 trials. The induced coronary spasms associated with isolated negative U waves were of Grade 1 in 9 of the 10 trials. In contrast, all of the coronary spasms associated with negative U waves and ST elevation had a Grade of > or = 2. In conclusion, the coronary angiographic finding associated with isolated negative U waves is coronary spasm with delayed filling of the distal coronary artery, with opacification of the entire coronary bed.
在24例变异型心绞痛患者中，研究了孤立性负向U波与诱发冠状动脉痉挛严重程度之间的关系，以确定孤立性负向U波出现时的心肌缺血程度。通过向左冠状动脉注射递增剂量的乙酰胆碱或麦角新碱来诱发冠状动脉痉挛。冠状动脉痉挛被量化为4级：0级 = 完全灌注，1级 = 部分灌注，2级 = 穿透但无灌注，3级 = 无灌注。当诱发≥2级的冠状动脉痉挛时，停止乙酰胆碱诱导。连续记录V1至V6导联的心电图和全身血压。15例患者可使用至少2剂乙酰胆碱诱发冠状动脉痉挛。所有≤1级的乙酰胆碱诱发的冠状动脉痉挛在3分钟内自发消失。19例（79%）患者出现负向U波，对这些患者进行了37次乙酰胆碱或麦角新碱注射试验。10次试验中检测到孤立性负向U波，8次试验中检测到负向U波和ST段压低，14次试验中检测到负向U波和ST段抬高。10次试验中有9次与孤立性负向U波相关的诱发冠状动脉痉挛为1级。相比之下，所有与负向U波和ST段抬高相关的冠状动脉痉挛均≥2级。总之，与孤立性负向U波相关的冠状动脉造影表现为冠状动脉痉挛伴远端冠状动脉延迟充盈，整个冠状动脉床显影。
