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Complete definite positive spasm on acetylcholine spasm provocation tests: comparison of clinical positive spasm

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Abstract

In the clinical grounds, patients with ≥90 % luminal narrowing during acetylcholine (ACh) testing had variable response. We investigated ischemic findings and chest symptoms in patients with ≥90 % luminal narrowing when performing ACh tests, retrospectively. We performed 763 ACh tests over 13 years (2001–2013). We analyzed chest symptoms and positive ischemic ECG changes during ACh tests. More than 90 % luminal narrowing was found in 441 patients (57.8 %) including 355 patients in the right coronary artery (RCA) and 363 patients in the left coronary artery (LCA). Chest symptom was observed in 386 patients (87.5 %) including 293 patients in the RCA and 304 patients in the LCA. ST elevation was found in 161 patients including 110 in the RCA and 85 patients in the LCA, while ST depression was recognized in 146 patients including 119 patients in the RCA and 117 patients in the LCA. Three quarter of patients with ≥90 % luminal narrowing had significant ischemic ECG changes, whereas two-third of patients with ≥90 % luminal narrowing complained usual chest pain accompanied with significant ischemic ECG changes. Unusual chest symptom was complained in 7.3 % patients with ≥90 % luminal narrowing. Neither chest symptom nor ECG changes were found in 30 patients (6.8 %) with ≥90 % luminal narrowing. A third of these patients had ischemic findings on non-invasive tests before catheterization and six patients had subtotal or total occlusion. We should realize some limitation to define positive coronary spasm based on the ischemic ECG change and chest symptom during ACh tests.

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References

  1. Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y (2008) Coronary artery spasm-clinical features, diagnosis, pathogenesis, and treatment. J Cardiology 51:2–17

    Article  Google Scholar 

  2. Koyanagi S, Takeshita A, Nakamura M (1989) Clinical characteristics of sudden cardiac death in patients with vasospastic angina. Jpn Circ J 53:1541–1545

    Article  CAS  PubMed  Google Scholar 

  3. Shimokawa H, Nagasawa K, Irie T, Egashira S, Egashira K, Sagara T, Kikuchi Y, Nakamura M (1988) Clinical characteristics and long-term prognosis of patients with variant angina. A comparative study between western and Japanese populations. Int J Cardiol 18:331–349

    Article  CAS  PubMed  Google Scholar 

  4. Yasue H, Takizawa A, Nagao M, Nishida S, Horie M, Kubota J, Omote S, Takaoka K, Okumura K (1988) Long-term prognosis for patients with variant angina and influential factors. Circulation 78:1–9

    Article  CAS  PubMed  Google Scholar 

  5. Takagi Y, Yasuda S, Takahashi J, Takeda M, Nakayama M, Ito K, Hirose M, Wakayama Y, Fukuda K, Shimokawa H (2009) Importance of dual induction tests for coronary vasospasm and ventricular fibrillation in patients surviving out-of-hospital cardiac arrest. Cir J 73:767–769

    Article  Google Scholar 

  6. Sueda S, Hiroaki K (2009) Dual induction tests save patients surviving out-of-hospital cardiac arrest: The revival of coronary spasm. Circ J 73:630–631

    Article  PubMed  Google Scholar 

  7. Pristipino C, Beltrame JF, Finocchiaro ML, Hattori R, Fujita M, Mongiardo R, Cianflone D, Sanna T, Sasayama S, Maseri A (2000) Major racial differences in coronary constrictor response between Japanese and Caucasians with recent myocardial infarction. Circulation 101:1102–1108

    Article  CAS  PubMed  Google Scholar 

  8. Sueda S, Ochi N, Kawada H, Matsuda S, Hayashi Y, Tsuruoka T, Uraoka T (1999) Frequency of provoked coronary vasospasm in patients undergoing coronary arteriography with spasm provocation test of acetylcholine. Am J Cardiol 83:1186–1190

    Article  CAS  PubMed  Google Scholar 

  9. Beltrame JF, Sasayama S, Maseri A (1999) Racial heterogeneity in coronary artery vasomotor reactivity: differences between Japanese and Caucasian Patients. J Am Coll Cardiol 33:1442–1452

    Article  CAS  PubMed  Google Scholar 

  10. Seo SM, Kim PJ, Shin DII, Kim TH, Kim CJ, Min J, Koh YS, Park HJ, Kim DB, Her SH, Chang KY, Baek SH, Chung WS, Seung KB (2013) Persistent coronary artery spasm documented by follow-up coronary angiography in patients with symptomatic remission of variant angina. Heart Vessels 28:301–307

    Article  PubMed  Google Scholar 

  11. Yasue H, Horio Y, Nakamura N, Fujii H, Imoto N, Sonoda R, Kugiyama K, Obata K, Morikami Y, Kimura T (1986) Induction of coronary artery spasm by acetylcholine in patients with variant angina : possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm. Circulation 74:955–963

    Article  CAS  PubMed  Google Scholar 

  12. Okumura K, Yasue H, Matsuyama K, Goto K, Miyagi H, Ogawa H, Matsuyama K (1988) Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm. J Am Coll Cardiol 12:883–888

    Article  CAS  PubMed  Google Scholar 

  13. Okumura K, Yasue H, Horio Y, Takaoka K, Matsuyama K, Kugiyama K, Fujii H, Morikami Y (1988) Multivessel coronary spasm in patients with variant angina: a study with intracoronary injection of acetylcholine. Circulation 77:535–542

    Article  CAS  PubMed  Google Scholar 

  14. JCS Joint Working Group (2010) Guidelines for diagnosis and treatment for patients with vasospastic angina (coronary spastic angina) (JCS 2008): Digest version. Circ J 74:1745–1762

    Article  Google Scholar 

  15. Sueda S, Kohno H, Fukuda H, Ochi N, Kawada H, Hayashi Y, Uraoka T (2004) Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations. Coron Artery Dis 15:491–497

    Article  PubMed  Google Scholar 

  16. Sueda S, Saeki H, Otani T, Mineoi K, Kondou T, Yano K, Ochi T, Ochi N, Hayashi Y, Tsuruoka T, Kawada H, Matsuda S, Uraoka T (2000) Major complications during spasm provocation tests with an intracoronary injection of acetylcholine. Am J Cardiol 85:391–394

    Article  CAS  PubMed  Google Scholar 

  17. Sueda S, Fukuda H, Watanabe K, Ochi N, Kawada H, Hayashi Y, Uraoka T (2001) Usefulness of accelerated exercise following mild hyperventilation for the induction of coronary artery spasm: Comparison with an acetylcholine test. Chest 119:155–162

    Article  CAS  PubMed  Google Scholar 

  18. Sueda S, Kohno H, Miyoshi T, Sakaue T, Sasaki Y, Habara H (2014) Maximal acetylcholine dose of 200 μg into the left coronary artery as a spasm provocation test: comparison with 100 μg of acetylcholine. Heart Vessels. doi:10.1007/s00380-014-0563-y

    Google Scholar 

  19. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, McGon DC, Murphy ML, Roe BB (1975) A reporting system on patients evaluated for coronary artery disease. Report of the ad hoc committee for grading of coronary artery disease, council on cardiovascular aurgery. American Heart Association. Circulation 51:5–40

    Article  CAS  PubMed  Google Scholar 

  20. Sato K, Kaikita K, Nakayama N, Horio E, Yoshimura H, Ono T, Ohba K, Tsujita K, Kojima S, Tayama S, Hokimoto S, Matsui K, Sugiyama S, Yamabe H, Ogawa H (2013) Coronary vasomotor response to intracoronary acetylcholine injection, clinical features, and long-term prognosis in 873 consecutive patients with coronary spasm: analysis of a single-center study over 20 years. J Am Heart Assoc 2:e000227

    Article  PubMed Central  PubMed  Google Scholar 

  21. Sueda S, Miyoshi T, Sasaki Y, Sakaue T, Habara H, Kohno H (2014) One of six patients with non-ischemic heart disease exhibit provoked coronary spasms: non-ischemic heart disease associated with ischemia? Intern Med (in press)

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Acknowledgments

We acknowledge the helpful comments of Professor Yuji Shigematsu, MD, Professor Mareomi Hamada, MD, Professor Jitsuo Higaki, MD and professor Kunio Hiwada, MD.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Ehime Niihama Prefectural Hospital, Hongou 3 choume 1-1, Niihama City, Ehime Prefecture, 792-0042, Japan

    Shozo Sueda, Toru Miyoshi, Yasuhiro Sasaki, Kousei Ohshima, Tomoki Sakaue, Hirokazu Habara & Hiroaki Kohno

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  1. Shozo Sueda
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  2. Toru Miyoshi
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  3. Yasuhiro Sasaki
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  4. Kousei Ohshima
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  5. Tomoki Sakaue
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  6. Hirokazu Habara
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  7. Hiroaki Kohno
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Correspondence to Shozo Sueda.

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Sueda, S., Miyoshi, T., Sasaki, Y. et al. Complete definite positive spasm on acetylcholine spasm provocation tests: comparison of clinical positive spasm. Heart Vessels 31, 143–151 (2016). https://doi.org/10.1007/s00380-014-0595-3

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  • DOI: https://doi.org/10.1007/s00380-014-0595-3

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