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Myocardial cell damage during attacks of vasospastic angina in the absence of persistent electrocardiographic changes
Insights
Vasospastic angina may cause myocardial cell damage, even without ECG changes. Biomarkers like myoglobin and creatine kinase MB indicate damage after angina episodes.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Vasospastic angina (VWA) is characterized by transient coronary artery spasms.
- The potential for myocardial cell damage in VWA, especially without persistent electrocardiogram (ECG) abnormalities, remains under investigation.
Purpose of the Study:
- To determine if vasospastic angina attacks are associated with myocardial cell damage, even in the absence of permanent QRS or ST-T changes on ECG.
Main Methods:
- Serum levels of creatine kinase MB (CK-MB), myoglobin, and alpha hydroxybutyrate dehydrogenase were measured in 15 patients with VWA.
- Time-activity curves of these cardiac biomarkers were analyzed.
- Myocardial uptake of 99mTc pyrophosphate was assessed in some patients.
Main Results:
- A transient rise and fall in myoglobin and CK-MB levels was observed in 7 patients, correlating with myocardial uptake in 4.
- Myoglobin alone showed a similar pattern in 3 additional patients.
- No significant changes in alpha hydroxybutyrate dehydrogenase were detected in any patient.
Conclusions:
- The observed fluctuations in myocardial cytosolic components suggest that cell damage can occur during vasospastic angina episodes.
- This damage may happen even when there are no persistent ECG abnormalities like QRS or ST-T changes.
Abstract:
We have investigated whether vasospastic anginal attacks might be associated with myocardial cell damage even when permanent ORS or ST-T changes are absent. We obtained serum time-activity curves of creatine kinase MB, of myoglobin, and of alpha hydroxybutyrate dehydrogenase in 15 patients with vasospastic angina admitted to our Coronary Care Unit (CCU). A slight but consistent rise and fall of both myoglobin and creatine kinase MB was observed in 7 patients (4 presented a definitive myocardial uptake of 99mTc pyrophosphate, and I had a faint deposition). A similar pattern was observed for myoglobin alone in 3 patients (1 presented a negative myocardial scan), while no consistent changes were found in the remaining 5 patients (2 presented a faint deposition of 99mTc pyrophosphate). No significant change of alpha hydroxybutyrate dehydrogenase was observed in any of the patients. The coherent rise and fall of the levels of myocardial cytosolic components after prolonged episodes of vasospastic angina suggests that cell damage may occur even in the absence of persistent QRS and ST-T changes.