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[Evaluation of coronary flow reserve in patients with vasospastic angina]
1Department of Cardiology, General Ohta Hospital, Gunma.
Insights
Patients with vasospastic angina exhibit microvascular impairment, particularly in distal arteries with vasospasm. This study highlights impaired coronary flow reserve in affected individuals.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Context:
- Vasospastic angina (VSA) is characterized by coronary artery spasms.
- Microvascular dysfunction is increasingly recognized as a contributor to VSA.
- Evaluating microvascular function is crucial for understanding VSA pathophysiology.
Purpose:
- To assess microvascular impairment in patients diagnosed with vasospastic angina using the acetylcholine provocation test.
- To compare coronary flow reserve (CFR) between vessels with and without vasospasm.
- To investigate the impact of focal versus diffuse vasospasm and distal artery involvement on CFR.
Summary:
- Coronary flow reserve (CFR) was measured in 72 patients with chest pain and no significant coronary stenosis.
- Patients with vasospastic angina showed significantly lower CFR in vessels with vasospasm compared to those without.
- Microvascular impairment was evident in both vasospastic and non-vasospastic vessels, with more prominent impairment in distal arteries affected by vasospasm.
Impact:
- This study demonstrates that microvascular impairment is a key feature of vasospastic angina.
- Findings suggest that distal microvascular dysfunction plays a significant role in VSA.
- Understanding microvascular involvement can lead to improved diagnostic and therapeutic strategies for VSA.
Objectives:
The presence of microvascluar impairment was evaluated in 154 patients with vasospastic angina identified by the acetylcholine provocation test.
Methods:
Coronary flow reserve was evaluated with a Doppler flow guidewire in 128 vessels of 72 patients with chest pain, but no significant coronary stenosis(less than 50% stenosis) and no clinical factors that affect coronary flow reserve. Coronary flow reserve was obtained from the ratio of adenosine triphosphate-induced maximum/baseline averaged peak velocity. These vessels were classified into 2 categories according to whether acetylcholine-induced vasospasm was positive or negative. Vasospasm positive was defined as more than 90% stenosis provoked with chest pain and/or ischemic ST change. Positive vessels were subdivided according to focal or diffuse vasospasm. These vessels were also classified into 2 other categories according to whether vasospasm in the distal artery was positive or negative.
Results:
Coronary flow reserve was significantly lower in vessels with vasospasm than in vessels without vasospasm in patients without vasospasm(2.9 +/- 0.8 vs 3.6 +/- 1.0, p = 0.0005). Coronary flow reserve was significantly lower in vessels without vasospasm in patients with vasospasm than in vessels without vasospasm in patients without vasospasm(3.0 +/- 0.8 vs 3.6 +/- 1.0, p = 0.03). There was no significant difference in coronary flow reserve between vessels with vasospasm and vessels without vasospasm in patients with vasospasm(2.9 +/- 0.8 vs 3.0 +/- 0.8, p = 0.8). There was no significant difference in coronary flow reserve between focal and diffuse vasospasm(3.2 +/- 0.8 vs 2.9 +/- 0.8, p = 0.3). Coronary flow reserve was significantly lower in vessels with vasospasm in the distal artery than in vessels without vasospasm in the distal artery (2.8 +/- 0.8 vs 3.4 +/- 1.0, p = 0.004).
Conclusions:
Patients with vasospastic angina have microvascular impairment in both vessels with vasospasm, and vessels without vasospasm. Microvascular impairment is prominent in vessels with vasospasm in the distal artery.