[Show abstract][Hide abstract] ABSTRACT: There have been no reports concerning the correlation between heart failure and coronary artery spasm.
From January 2000 to December 2007, 201 patients with heart failure were hospitalized at our institution. We could perform coronary arteriography and spasm provocation tests in 37 (22 men, 67±11 years) out of 201 patients with heart failure before discharge. Atrial fibrillation was observed in 13 patients (35%). After controlling heart failure and 24h cessation of vasoactive drugs, pharmacological spasm provocation tests were performed. Positive spasm was defined as >90%. Coronary spasm was observed in 12 patients (32%) and multiple spasm was recognized in 10 (83%) out of 12 patients. Though ejection fraction on admission was not different between the two groups (42±18% vs. 43±11%, ns), left ventricular end-diastolic and end-systolic dimension after medical therapy over 1 year was significantly smaller in patients with positive spasm than that in patients with negative spasm. There was no difference concerning medications except the administration of nitrate and nicorandil between two groups.
Coronary artery spasm, especially multiple spasm, may cause transient heart failure in a small part of unknown origin heart failure in Japan.
Preview · Article · Dec 2009 · Journal of Cardiology
[Show abstract][Hide abstract] ABSTRACT: We examined some recommendations for performing acetylcholine (ACh) tests safely.
We performed 1000 ACh tests from 1991 to December 2004. ACh was injected in incremental doses of 20/50/80 microg into the RCA and of 20/50/100 microg into the LCA. During these periods, we encountered various major/minor complications; 12 ventricular tachycardia (1.2%) necessary one dc, one ventricular fibrillation (0.1%) necessary dc, 3 shock like the left main stem spasm (0.3%), one cardiac tamponade necessary surgical drainage (0.1%), and 164 Paf (164/959:17.1%) necessary administration of antiarrhythmic agents to sinus rhythm in about one third patients (31.7%). We did not experience irreversible severe complications, such as acute myocardial infarction or death.
(1) Stand by direct current with pasting, (2) Thump version when ventricular tachycardia or fibrillation occurred, (3) Over infusion to avoid hypovolemia, (4) Perform angiography before complete spasm provocation if a severe spasm, (5) Drainage if cardiac tamponade occurred, (6) Cibenzoline or disopyramid administration when ACh induced paroxysmal atrial fibrillation, (7) Incremental ACh dose up should be performed, (8) Administer small amount of noradrenaline if shock observed and (9) Test shot should be performed before 1-min angiography.
We recommend STOP DCIAT for performing ACh tests safely.
Preview · Article · Apr 2008 · Journal of Cardiology
[Show abstract][Hide abstract] ABSTRACT: Calcium antagonists (Ca) have been effective in reducing angina attacks in patients with variant angina. However, there are no reports regarding the effectiveness of Ca on myocardial fatty acid metabolic images in patients with pure coronary spastic angina (CSA).
This study sought to examine the correlation between myocardial fatty acid metabolic images and the medical treatment of Ca in patients with pure CSA.
This study included 35 consecutive patients (28 men, mean age of 66 +/- 10 years) with angiographically confirmed coronary spasm and no fixed stenosis. Long-acting Ca was administered to all 35 patients. Isosorbide dinitrate /nicorandil/another Ca/beta-bloker were administered when chest pain was not controlled. Using an iodinated fatty acid analogue, 15-(p-[iodine-123]iodophenyl)-3-(R,S)methylpentadecanoic acid (BMIPP), myocardial scintigraphies with intravenous adenosine triphosphate infusion were performed before cardiac catheterization and 12 mo after medical therapy. According to the medical control states, these 35 patients were classified into 3 groups; response (disappearance of angina attacks, 12 pts, 60 +/- 11 years), partial response (angina attacks < 4/mo, 12 pts, 67 +/- 10 years), and no response to therapy (angina attacks > or = 4/mo, 11 pts, 71 +/- 6 years). Reduced BMIPP uptake was observed in 24 (69%) of 35 patients before the treatment. Reduced BMIPP uptake was also found in 18 patients (51%) after 12 mo. Normal BMIPP uptake after 12 mo therapy was observed in about half (response: 42%, partial response: 58%, no response: 45%) of patients among the 3 groups. There was no difference regarding the value of washout rate (WOR) (response; 10 +/- 7 (before), 14 +/- 8% (12 mo)), partial response; 11 +/- 7, 10 +/- 5%, no response; 13 +/- 9, 14 +/- 8%) among the 3 groups. The defect scores of BMIPP in the three groups were not different during at least one year medical therapy. No difference regarding the distribution of other medical therapies (angiotensin converting enzyme inhibitors/angiotensin receptor blockers/beta-blockers/statins) was found. The administration of Ca and isosorbide dinitrate/nicorandil and 2 Ca was significantly higher in the poor than in the good control patients.
Long-acting Ca over one year did not improve myocardial fatty acid metabolic images in patients with pure CSA. This may be related to silent ischemia.
No preview · Article · Feb 2007 · Annals of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Four patients suffered shock during the spasm provocation test with acetylcholine. An 84-year-old man with acute coronary syndrome was treated with stent implantation in the mid left anterior descending artery. Before discharge, acetylcholine test demonstrated coronary spasm in both the proximal left anterior descending artery and proximal left circumflex artery. A 61-year-old woman was admitted to the hospital because of recurrent rest and effort chest pain. Coronary arteriography showed no significant stenosis but shock was observed by intracoronary injection of acetylcholine due to diffuse severe coronary vasospasm in the proximal left anterior descending artery and left circumflex artery. Shock occurred in 4 of 1110 (0.36%) consecutive acetylcholine tests. Coronary spasm was gradually relieved and recovered from shock by the intraarterial administration of small amounts of norepinephrine and isosorbide dinitrate. Although the acetylcholine spasm provocation test is safe and reliable, care is required even during a selective procedure.
Preview · Article · Feb 2007 · Journal of Cardiology
[Show abstract][Hide abstract] ABSTRACT: The spasm provocation test (SPT)is no longer widely used in patients with undiagnosed chest pain syndromes in the USA and Europe. Objectives. The clinical significance of the SPT was examined in Japan and compared with the frequency of coronary spastic angina (CSA) in institutions with and without SPT screening.
Questionnaires concerning the number of cases of coronary angiography (CAG), percutaneous coronary intervention (PCI), and invasive/non-invasive SPT in 2005 were sent to members of the Japanese Circulation Society in 1,177 cardiology hospitals. Completed surveys were returned from 208 hospitals (17.7%). Non-invasive SPT was performed in only 27 hospitals (13.0%). Invasive SPT was not performed in 50 (24.0%) institutions, and performed in the remaining 158 institutions(< 10 cases/year: 29.8%, > or = 10< 50: 33.7%, > or = 50< 100: 8.7%, > or = 100: 3.8%). There was a close correlation between the number of acetylcholine/ergonovine SPTs and the number of CSA cases finally diagnosed (acetylcholine: r(2)= 0.907, ergonovine: r(2) = 0.76). There was no difference in the number/year of CAG (525+/-451 vs 513 +/-888, NS) and PCI(175+/-156 vs 144+/-225, NS) between institutions with and without SPT screening. However, the number of CSA cases (15.6+/-21.6 vs 4.2 +/-13.0, p < 0.01) and variant angina cases (3.3+/-7.2 vs 1.4+/-2.4)in hospitals with SPT screening was higher than hospitals without SPT screening.
If Japanese cardiologists discontinue use of the SPT as in the USA and Europe, occurrence of CSA may disappear in the near future in Japan.
No preview · Article · Feb 2007 · Journal of Cardiology
[Show abstract][Hide abstract] ABSTRACT: Objectives : We examined the clinical usefulness of the acetylcholine-induced coronary artery spasm provocation test by simultaneous brachial artery and vein approach with the Tometakun compression device. Methods and Results : We performed 305 (217 men, 64.9±10.8 years) brachial approach cardiac catheterization procedures with simultaneous artery (5Fr) and vein (5-6Fr) insertion over 6 years. Vein access was performed through either the cephalic or basillic vein near the brachial artery access point. After the procedures, we compressed both access sites simultaneously with the Tometakun device for at least 5 hours. Insertion success rate for the brachial artery was perfect and for the veins was 91.8% (280/305). Overall, the procedure success rate was 91.8%. Failure of vein puncture was found in 19 cases and after wire insertion we could not cannulate the sheath in 6 patients. The procedure failure rate in female patients was higher than that in male patients, but not significantly (6.5% vs. 12.5%, ns). No bleeding or hematoma, central nerve palsy, arterio-venous fistula nor obstruction of vein were observed when we used the Tometakun as a compression device in all patients. Conclusions : We recommend the simultaneous brachial artery and vein approach cardiac catheterization with the Tometakun compression device when performing acetylcholine spasm provocation tests.
No preview · Article · Jan 2007 · Japanese Journal of Interventional Cardiology
[Show abstract][Hide abstract] ABSTRACT: An 81-year-old male was suspected to have right renal artery stenosis (RAS) by duplex ultrasonography. In the anteroposterior projection, we couldn't identify the RAS. In the right anterior oblique projection, slit-like stenosis became clear. Intravascular ultrasound (IVUS) detected 70% stenosis with eccentric plaque. Due to the presence of an abdominal aortic aneurysm, PTRA was performed employing brachial vascular access and using devices for coronary intervention. Stenting was performed to the residual stenosis after ballooning. Minimum lumen diameter measured by IVUS was 5.0 X 5.4 mm after post-dilatation. Definitive diagnosis of RAS, especially right RAS, is often angiographically difficult. We suppose that IVUS is recommended as a diagnostic tool and for assessment of the need for post-dilatation.
No preview · Article · Jan 2007 · Japanese Journal of Interventional Cardiology
[Show abstract][Hide abstract] ABSTRACT: We retrospectively investigated the patient's characteristics and selection of therapeutic drugs which might have affected the outcome in patients with coronary spastic angina. Patient's characteristics, therapeutic drugs and cardiovascular events were analyzed in 161 cases who had demonstrated drug-induced coronary spasm during provocative testing at our hospital from July, 1998 to end-September, 2005, The correlation of these parameters with the prognosis was studied. The analysis revealed that age, use of oral antidiabetics and uncontrolled chest pain proved to be significant poor prognostic factors. It was also shown that a diabetes complication and a greater number of affected branches tended to be correlated with poor prognosis. Ca antagonists were used to treat the disease in 92% of the patients; benidipine hydrochloride in 32%, amlodipine besilate in 22%, diltiazem hydrochloride in 29% and others in 12%. The correlation of Ca antagonists with the prognosis was studied in patients with moderate disease having no history of diabetes and having induced spasm in one or two branches. The outcome was better in the order of benidipine, diltiazem and amlodipine. In conclusion, this study showed that age, diabetes and chest pain control are significantly correlated with the prognosis in coronary spastic angina. Moreover, the possibility that selection of Ca antagonists may affect the outcome of the disease was also indicated.
No preview · Article · Nov 2006 · Kokyu to junkan. Respiration & circulation
[Show abstract][Hide abstract] ABSTRACT: Objectives: Our purpose was to investigate what was the standard for cardiology management in Japan. Methods: We examined the total number of cardiac catheterizations (CA), percutaneous coronary interventions (PCI), selective acetylcholine and ergonovine spasm provocation tests (SSPT), 24-hour Holter monitoring (24 H), and treadmill exercise tests (TME) during the last 3 years (2001-2003) by questionnaire in the 120 cardiology hospitals in the area of Chugoku and Shikoku. The ratio compared with the total number of PCI was analyzed. Results: 1) Collection rate was 38% (45/120). 2) The total number of CA, PCI, SSPT, 24 H, and TME during the last 3 years was 92,035, 24,145, 78,370, and 34,026, respectively. 3) Mean ratio of CA/PCI, SSPT/PCI, 24H/PCI, and TME/PCI at each hospital was 4.16±1.18(1.92-7.76), 0.25±0.36(0-1. 74), 6.55±7.02(0-22.54), and 2.85±4.13 (0-19.84), respectively. 4) A significant correlation between the number of CA and the number of PCI was found, but the other three examinations did not correlate with the number of PCI. 5) Differentials among each hospital were remarkably high. The majority of hospitals disliked the selective spasm provocation tests and non-invasive tests. 6) The value of SSPT/PCI, 24 H/PCI and TME/PCI in institutes licensed training and relevance by the Japanese Society of Interventional Cradiology was significantly lower than in those institutes without both licenses. Conclusions: Japanese large volume cardiology interventional centers tended to mostly performe PCI and paid little attention to non-invasive tests or selective spasm provocation tests. It is necessary to document guidelines for non-invasive tests and spasm provocation tests as well as PCI.
No preview · Article · Jan 2006 · Japanese Journal of Interventional Cardiology
[Show abstract][Hide abstract] ABSTRACT: Because there are no guidelines concerning coronary spasm in Japan, the present study examined the current status of the spasm provocation test.
Questionnaires concerning the number of cases of coronary angiography, percutaneous coronary intervention, and invasive/non-invasive spasm provocation tests over 3 years (2001-2003) and the status of spasm provocation tests were sent to members of the Japanese Circulation Society in 120 cardiology hospitals in the Chugoku and Shikoku areas. Completed surveys were returned from 45 hospitals, giving a collection rate of 38%. As a spasm provocation agent, acetylcholine tests were performed in 29 hospitals, and ergonovine tests in 18 hospitals. Non-invasive spasm provocation tests were performed in only 9 hospitals (20%). In total, 5,267 patients underwent acetylcholine spasm provocation test (2,387 patients) or ergonovine spasm provocation test (2,880 patients) and vasospastic angina was diagnosed in 1,663 (2.4%) patients. Invasive spasm provocation tests were performed in 7.8% of patients with diagnostic catheterization and the spasm-positive rate was 31.6%. The difference among hospitals concerning the number of invasive spasm provocation tests was remarkable, and the angiographic spasm-positive standard and acetylcholine/ergonovine dose varied among the hospitals.
Guidelines on coronary spasm in Japan are essential to overcome the current differences between institutions.
No preview · Article · Dec 2005 · Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: Background Because there are no guidelines concerning coronary spasm in Japan, the present study examined the current status of the spasm provocation test. Methods and Results Questionnaires concerning the number of cases of coronary angiography, percutaneous coronary intervention, and invasive/non-invasive spasm provocation tests over 3 years (2001-2003) and the status of spasm provocation tests were sent to members of the Japanese Circulation Society in 120 cardiology hospitals in the Chugoku and Shikoku areas. Completed surveys were returned from 45 hospitals, giving a collection rate of 38%. As a spasm provocation agent, acetylcholine tests were performed in 29 hospitals, and ergonovine tests in 18 hospitals. Non-invasive spasm provocation tests were performed in only 9 hospitals (20%). In total, 5,267 patients underwent acetylcholine spasm provocation test (2,387 patients) or ergonovine spasm provocation test (2,880 patients) and vasospastic angina was diagnosed in 1,663 (2.4%) patients. Invasive spasm provocation tests were performed in 7.8% of patients with diagnostic catheterization and the spasm-positive rate was 31.6%. The difference among hospitals concerning the number of invasive spasm provocation tests was remarkable, and the angiographic spasm-positive standard and acetylcholine/ergonovine dose varied among the hospitals. Conclusions Guidelines on coronary spasm in Japan are essential to overcome the current differences between institutions.
No preview · Article · Nov 2005 · Circulation Journal