Related Experiment Video
Updated: Oct 3, 2026
Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm
Published on: September 17, 2021
Three-year follow-up of the Japanese patients with microvascular angina attributable to coronary microvascular spasm
A Masumoto1, M Mohri, A Takeshita
1Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Insights
Microvascular angina, often affecting postmenopausal women, shows excellent survival but persistent chest pain. Angiotensin converting enzyme inhibitors may improve angina symptoms when combined with calcium channel blockers.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Coronary microvascular spasm can cause angina in patients with normal coronary arteriograms.
- Long-term prognosis and treatment efficacy for microvascular angina remain unclear.
Purpose of the Study:
- To evaluate the long-term prognosis of patients with microvascular angina.
- To assess the effect of calcium channel blockers and other medications on angina symptoms.
Main Methods:
- Acetylcholine testing identified 68 patients with microvascular angina.
- Patients were treated with calcium channel blockers and followed for an average of 3.3 years.
Main Results:
- Microvascular angina predominantly affected postmenopausal women.
- No deaths occurred; 1% developed myocardial infarction.
- Angina improved in 64% of patients, but calcium channel blockers alone were insufficient for many.
- Combination therapy with ACE inhibitors showed improved angina status.
Conclusions:
- Microvascular angina has an excellent long-term survival rate, particularly in women.
- Angina often persists despite calcium channel blocker treatment.
- Angiotensin converting enzyme inhibitors may be beneficial as an adjunct therapy.
Background:
We recently reported that coronary microvascular spasm could cause angina in patients with chest pain and normal coronary arteriograms. However, the long-term prognosis of these patients or the effect of calcium channel blockers is not known.
Methods:
Of consecutive 283 patients who underwent acetylcholine testing for the evaluation of chest pain, we identified 68 patients with microvascular angina attributable to coronary microvascular spasm. All patients were discharged on calcium channel blockers and followed up for an average period of 3.3 years.
Results:
As compared with those having epicardial spasm (n=169), there was a female predominance in the microvascular spasm group (P<0.01), and 81% of the female patients were postmenopausal. During the follow-up, no patient died and one patient (1%) developed non-Q wave myocardial infarction. The frequency of chest pain was unchanged or increased in 24 patients (36%) and decreased or disappeared in 42 patients (64%). The angina status was improved only in 16 of 33 patients treated with calcium channel blockers alone. By contrast, it was improved in 18 of 21 patients on the combination of calcium channel blockers and angiotensin converting enzyme inhibitors (P<0.05).
Conclusions:
Patients with microvascular angina in the present study were more women and had a different risk factor profile as compared with those having epicardial spasm. Long-term prognosis was excellent with regard to mortality, but angina persisted in many patients even on calcium channel blockers. The result warrants prospective studies to evaluate the efficacy of angiotensin converting enzyme inhibitors as adjunct to calcium channel blockers in this population.
Related Concept Videos
01:29Angina III: Clinical Manifestations and Assessment
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Angina V: Nursing Management
01:26Angina IV: Management