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Shigemasa Tani,
Ken Nagao,
Takeo Anazawa,
Hirofumi Kawamata,
Shingo Furuya, Takeshi Fuji,
Hiroshi Takahashi,
Kiyoshi Iida,
Michiaki Matsumoto,
Takamichi Kumabe,
Yuichi Sato,
Atsushi Hirayama
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ABSTRACT: Focal vasospasm is reportedly involved in a high incidence of acute coronary syndrome (ACS) as compared with diffuse vasospasm. No adequate studies have been conducted on the mechanism underlying the higher incidence of ACS involving focal vasospasm than of those involving diffuse vasospasm in patients with coronary spastic angina.
Blood samples were collected from the aortic root (Ao) and the coronary sinus (CS) before provoking left coronary vasospasm using intracoronary administration of acetylcholine. After relief of vasospasm, volumetric analyses of vasospastic lesions were evaluated with 3-dimensional intravascular ultrasound in 64 patients. The percent plaque volume was more prominent in focal (n=31) than in diffuse vasospasm (n=33) (40.9+/-9.4 vs. 23.3+/-9.2%, p<0.0001). The Cs-Ao difference of malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, as a marker of atherothrombosis, in focal vasospasm increased significantly as compared with diffuse vasospasm (6.9+/-6.7 vs. 1.2+/-5.7 U/L, p=0.001). In a multiple-logistic regression analysis with the traditional risk factors, the Cs-Ao difference of MDA-LDL level was a variable differing independently between the 2 types of vasospasm.
Higher MDA-LDL levels were observed in the coronary circulation in patients with focal vasospasm than in those with diffuse vasospasm. Under these conditions, the dramatically increased percent plaque volume in cases with focal vasoconstriction may play an important role in the development of acute coronary events.
International journal of cardiology 07/2008; 135(2):202-6. · 7.08 Impact Factor
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Shigemasa Tani,
Ken Nagao,
Takeo Anazawa,
Hirofumi Kawamata,
Shingo Furuya,
Hiroshi Takahashi,
Kiyoshi Iida, Takeshi Fuji,
Michiaki Matsumoto,
Takamichi Kumabe,
Yuichi Sato,
Atsushi Hirayama
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ABSTRACT: Combined therapy with a statin and a calcium channel blocker, which can improve lipid metabolism and reduce oxidative stress, may attenuate coronary vasoconstriction in patients with coronary spastic angina (CSA). After 6 months of therapy with benidipine and pravastatin, an acetylcholine provocation test was performed a second time in 25 patients with CSA. The patients were divided into 2 groups according to whether the result of this second test was positive (n = 13) or negative (n = 12). The test was designated as positive when the intracoronary injection of acetylcholine induced angiographically demonstrable total or subtotal occlusion (positive-test group). In the negative-test group, significant decrease in the plasma levels of low-density lipoprotein (LDL) cholesterol (-20.7 +/- 11.1%, P < 0.01 versus baseline) were observed along with a dramatic increase in the serum level of high-density lipoprotein (HDL) cholesterol (26.8 +/- 13.2%, P < 0.01 versus baseline). Furthermore, a significant decrease of the malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, a marker of oxidative stress, was also observed (-22.6 +/- 14.1%, P < 0.01 versus baseline) in this group. In the positive-test group, however, no significant changes were found in any of the aforementioned parameters. The results showed that improvement of lipid metabolism, especially an increase of HDL cholesterol level and a reduction of MDA-LDL, may inhibit vascular contractility.
Journal of cardiovascular pharmacology 07/2008; 52(1):28-34. · 2.83 Impact Factor
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Shigemasa Tani,
Ikuyoshi Watanabe,
Takeo Anazawa,
Hirofumi Kawamata,
Eizo Tachibana, Takeshi Fuji,
Michiaki Matsumoto,
Motoyuki Onikura,
Yuichi Sato,
Ken Nagao,
Katsuo Kanmatsuse,
Toshio Kushiro,
Atsushi Hirayama
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ABSTRACT: We experienced a case of vasospastic angina showing resolution of vasospasm in the acetylcholine provocation test corresponding to regression of coronary atherosclerotic plaque following treatment with a combination of benidipine and pravastatin.
International journal of cardiology 04/2008; 125(1):e1-3. · 7.08 Impact Factor
