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Mechanisms of Coronary Artery Spasm

Kensuke Nishimiya1, Jun Takahashi1, Kazuma Oyama1

  • 1Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine Sendai, Japan.

European Cardiology
|July 17, 2023
PubMed

Insights

Percutaneous coronary intervention offers limited benefits for stable angina. This review explores coronary vasospasm mechanisms, highlighting Rho-kinase and inflammation in vascular smooth muscle cell contraction.

Area of Science:

  • Cardiovascular Research
  • Molecular Cardiology
  • Vascular Biology

Background:

  • Optimal medical therapy provides limited added benefit over percutaneous coronary intervention for stable angina.
  • Coronary vasomotion abnormalities are increasingly recognized in both obstructive and non-obstructive coronary artery disease.
  • Coronary vasomotion is a complex process regulated by the endothelium, vascular smooth muscle cells (VSMCs), autonomic nervous system, and inflammation.

Purpose of the Study:

  • To review landmark studies on the mechanisms of coronary artery spasm.
  • To elucidate the molecular pathways involved in coronary vasospasm.
  • To highlight the role of Rho-kinase and inflammation in VSMC hypercontraction.

Main Methods:

  • Review of landmark studies on coronary artery spasm mechanisms.
  • Analysis of animal models investigating coronary vasospasm.
  • Synthesis of research on molecular regulation of VSMC function.

Main Results:

  • Rho-kinase acts as a key molecular switch in VSMC hypercontraction.
  • Coronary adventitial inflammation plays a crucial role in upregulating Rho-kinase in VSMCs.
  • Multiple factors including endothelium, VSMCs, metabolic demand, autonomic nervous system, and inflammation regulate coronary vasomotion.

Conclusions:

  • Rho-kinase is a central mediator of coronary artery spasm.
  • Coronary adventitial inflammation is critical for Rho-kinase activation in VSMCs.
  • Understanding these mechanisms is vital for developing new therapeutic strategies for coronary vasospasm.

Keywords:
Coronary artery spasmRho-kinasecoronary adventitiainflammationperivascular adipose tissuevascular smooth muscle cells

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