Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2023; 15(1): 1-12
Published online Jan 26, 2023. doi: 10.4330/wjc.v15.i1.1
Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?
Hiroki Teragawa, Chikage Oshita, Yuko Uchimura
Hiroki Teragawa, Chikage Oshita, Yuko Uchimura, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Author contributions: Oshita C and Uchimura Y contributed to the acquisition of data and Teragawa H contributed to the writing and revision of the manuscript; All the authors approved the final version of the manuscript.
Institutional review board statement: This study was approved by the institutional review board of Medical Corporation JR Hiroshima Hospital.
Informed consent statement: Informed consent was obtained from all of the patients.
Conflict-of-interest statement: None of the authors have any conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroki Teragawa, FACC, FACP, FAHA, FESC, MD, PhD, Chief Physician, Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-Ku, Hiroshima, 732-0057, Japan. hiroki-teragawa@jrhh.or.jp
Received: August 28, 2022
Peer-review started: August 28, 2022
First decision: November 21, 2022
Revised: December 4, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 26, 2023
Processing time: 135 Days and 23 Hours
ARTICLE HIGHLIGHTS
Research background

Coronary spasm can be divided into two types: Focal spasm and diffuse spasm, but the prognosis for focal spasm is reported to be worse than that for diffuse spasm.

Research motivation

The cause of the worse prognosis in focal spasm is unclear, and although the degree of myocardial ischemia may be more severe in focal spasm, no method has been established to evaluate the severity of coronary spasm.

Research objectives

The objective of the present study was to investigate such relationships using a pressure wire during the spasm provocation test (SPT) in patients with vasospastic angina (VSA).

Research methods

Eighty-seven patients with VSA (average age: 67 years; 50 men, 37 women) underwent SPT. During SPT, a pressure wire was advanced into the distal portion of the right coronary artery and the left anterior descending coronary artery, and the ratio of intracoronary pressure to aortic pressure (Pd/Pa) was continuously monitored. An SPT was performed with acetylcholine (ACh), and the presence of coronary spasm was defined as the presence of > 90% arterial narrowing in response to an ACh infusion, with the usual chest symptoms and/or ischemic ECG changes. Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification, while diffuse spasm was defined as > 90% spasm with two or more segments. The group with focal spasm in at least one major coronary artery was classified as the focal group, and the group without focal spasm as the diffuse group.

Research results

Among 87 patients, the frequencies of metabolic syndrome and coronary atherosclerosis were higher in the focal group (n = 33) than in the diffuse spasm group (n = 54, P < 0.05). In vessel analyzes, in these 134 spastic segments, diffuse and focal spasms were detected in 100 and 34 vessels, respectively. Pd/Pa at baseline was similar in both groups (diffuse: 0.96 ± 0.05, focal: 0.95 ± 0.05, P = 0.35); however, Pd/Pa during coronary spasm was lower in focal spastic vessels (0.66 ± 0.20) than in diffuse spastic vessels (0.76 ± 0.11, P < 0.01), and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels (-0.29 ± 0.20) than in diffuse spastic vessels (-0.18 ± 0.11, P < 0.01). The presence of focal spasm was a significant factor responsible for the reduction in Pd/Pa during SPT.

Research conclusions

These findings suggest that focal spasm may be more severe than diffuse spasm, judging by intracoronary pressure during coronary spasm. This mechanism may be involved in the poor prognosis of focal spasm, and careful measures, such as intensified drug therapy, should be taken when focal spasm is detected.

Research perspectives

In recent years, more patients have been evaluated for coronary microvascular dysfunction using pressure wires and then for coronary artery spasm induced by ACh, and it is possible that pressure wires will be used more frequently to induce coronary artery spasm. It will be important to confirm the findings of this study in more cases.