Miyata S, Inoue H, Horimoto M, Hamasakai S, Shibuya E, Yoshimura H, Ohizumi S, Matsushima H, Igarashi K, Takenaka T
Division of Cardiology, Sapporo National Hospital, Japan.
Jpn Circ J. 1998 Sep;62(9):670-4. doi: 10.1253/jcj.62.670.
The association of the autonomic nervous system with coronary vasospasm has been controversial. The aim of the present study was to examine the involvement of the autonomic nervous system in coronary vasospasm by applying the head-up tilt (HUT) test to patients with coronary vasospastic angina. Fifteen consecutive patients with coronary vasospastic angina and without significant organic coronary stenoses underwent the HUT test. Prior to the test, coronary spasm was documented angiographically by using an intracoronary injection of acetylcholine or ergonovine. The HUT test was performed in the early morning and repeated in the afternoon if the test was positive in provoking angina pectoris and syncope or presyncope. If the test was negative, it was repeated under intravenous infusion of isoproterenol at a rate of 1-2 microg/min. The HUT test under isoproterenol infusion in the morning provoked vasospastic angina with syncope or presyncope in 9 of the 15 patients. In the test-positive group, heart rate was significantly reduced (104+/-17 beats/min to 84+/-25 beats/min, p<0.05), which preceded a reduction in systolic blood pressure (158+/-25 mmHg to 125+/-17 mmHg, p<0.001), angina attack and syncope. The HUT test without isoproterenol infusion in the morning and the HUT test in the afternoon with or without isoproterenol infusion failed to provoke angina. The heart rate reduction preceding reduced systemic blood pressure and anginal attack suggested that parasympathetic nerve excitation plays an important role in coronary vasospasm. The results also implied that the HUT test combined with isoproterenol infusion is useful for the provocation of coronary spasm.
自主神经系统与冠状动脉痉挛之间的关联一直存在争议。本研究的目的是通过对冠状动脉痉挛性心绞痛患者应用头高位倾斜（HUT）试验，来检验自主神经系统在冠状动脉痉挛中的作用。连续15例冠状动脉痉挛性心绞痛且无明显器质性冠状动脉狭窄的患者接受了HUT试验。在试验前，通过冠状动脉内注射乙酰胆碱或麦角新碱进行血管造影记录冠状动脉痉挛情况。HUT试验在清晨进行，如果试验在诱发心绞痛、晕厥或接近晕厥方面呈阳性，则在下午重复进行。如果试验为阴性，则在以1 - 2微克/分钟的速率静脉输注异丙肾上腺素的情况下重复进行。15例患者中有9例在清晨输注异丙肾上腺素时进行的HUT试验诱发了伴有晕厥或接近晕厥的血管痉挛性心绞痛。在试验阳性组中，心率显著降低（从104±17次/分钟降至84±25次/分钟，p<0.05），这先于收缩压降低（从158±25毫米汞柱降至125±17毫米汞柱，p<0.001）、心绞痛发作和晕厥。清晨未输注异丙肾上腺素时的HUT试验以及下午无论是否输注异丙肾上腺素的HUT试验均未能诱发心绞痛。全身血压降低和心绞痛发作之前的心率降低表明副交感神经兴奋在冠状动脉痉挛中起重要作用。结果还表明，HUT试验联合异丙肾上腺素输注对诱发冠状动脉痉挛是有用的。
