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Sueda S, Kohno H. Spontaneous coronary artery spasm detected by computed tomography coronary angiography: Provoked spasm site similar to intracoronary injection of ergonovine but not acetylcholine. J Cardiol Cases 2019; 20:209-212. [PMID: 31762835 DOI: 10.1016/j.jccase.2019.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/05/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022] Open
Abstract
A 61-year-old man was admitted to our hospital due to chest pain on both rest and effort. After the computed tomography coronary angiography, coronary stenosis was recognized at segment 3. Because inferior ischemia on stress myocardial perfusion scintigraphy with 201 thallium chloride induced by adenosine was found, we planned to perform the coronary intervention. After control coronary angiography, no significant stenosis was found in the right coronary artery. Intracoronary acetylcholine testing disclosed diffuse spasm at segment 4, whereas intracoronary ergonovine administration documented the total spasm at segment 3. After the intracoronary administration of nitrate, we diagnosed him with coronary spastic angina without organic stenosis. <Learning objective: We describe a case of coronary spastic angina whose spontaneous coronary spasm was detected by computed tomography coronary angiography incidentally.>.
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Affiliation(s)
- Shozo Sueda
- Department of Cardiology, Ehime Niihama Prefectural Hospital, Ehime, Japan
| | - Hiroaki Kohno
- Department of Cardiology, Tsukazaki Hospital, Himeji, Japan
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Nakayama M, Hirano M, Goto S, Watanabe A, Uchiyama T. Coronary arterial spasm detected by coronary computed tomography angiography and confirmed by intravascular ultrasound. Radiol Case Rep 2018; 13:14-17. [PMID: 29552237 PMCID: PMC5850873 DOI: 10.1016/j.radcr.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/21/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
A 40-year-old man was admitted to our hospital for chest pain after smoking. Coronary computed tomography angiography showed severe stenosis in the left anterior descending artery. The stenosis site had no plaque on stretched curved multiplanar reconstruction and short-axis images. Coronary angiography revealed improvement of the severe stenosis after the intracoronary administration of isosorbide dinitrate in the left anterior descending artery. Intravascular ultrasound demonstrated negative remodeling without a plaque and diffuse intima with media thickening at the stenosis site. The chest pain was likely caused by coronary spastic angina, which was treated with diltiazem hydrochloride.
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Affiliation(s)
- Masafumi Nakayama
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
- Corresponding author.
| | - Masaharu Hirano
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Sonoka Goto
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Akifumi Watanabe
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
| | - Takashi Uchiyama
- Cardiovascular Center, Toda Central General Hospital, Toda, Japan
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Kang EJ, Kim MH, De Jin C, Seo J, Kim DW, Yoon SK, Park TH, Lee KN, Choi SI, Yoon YE. Noninvasive detection of coronary vasospastic angina using a double-acquisition coronary CT angiography protocol in the presence and absence of an intravenous nitrate: a pilot study. Eur Radiol 2016; 27:1136-1147. [PMID: 27380904 DOI: 10.1007/s00330-016-4476-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 05/04/2016] [Accepted: 06/20/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate the feasibility of a double-acquisition coronary CT angiography (CCTA) protocol in the presence and absence of an intravenous (IV) vasodilator infusion for detecting vasospastic angina. METHODS Twenty patients with a high clinical probability of vasospastic angina were enrolled. All subjects underwent baseline CCTA without a vasodilator in the early morning followed by a catheterized coronary angiography with ergonovine provocation test. Within 3 days, all subjects underwent repeat CCTA during a continuous IV infusion of nitrate. Vasospastic angina as detected by CCTA was defined as significant stenosis (≥50 %) with negative remodelling without definite plaques or diffuse small diameter (<2 mm) of a major coronary artery with a beaded appearance on baseline CT that completely dilated on IV nitrate CT. The CCTA results were compared to the catheterized ergonovine provocation test as the reference standard. RESULTS Among 20 patients, the catheterized ergonovine provocation test detected vasospasm in 15 patients. The sensitivity, specificity, positive predictive value and negative predictive value of CCTA in a per-patient-based analysis were 73, 100, 100 and 56 %, respectively. CONCLUSIONS Double-acquisition CCTA in the presence and absence of IV infusion of nitrate allows noninvasive detection of vasospastic angina with moderate sensitivity and high specificity. KEY POINTS • Limited data exist regarding the efficacy of CCTA in detecting vasospastic angina. • We propose a double-acquisition CCTA protocol with and without IV nitrate injections. • This protocol provides 100% specificity and moderate sensitivity (73%) in spasm detection.
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Affiliation(s)
- Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea. .,Global Clinical Trial Center, Dong-A University Hospital, Busan, Republic of Korea.
| | - Cai De Jin
- Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea.,Global Clinical Trial Center, Dong-A University Hospital, Busan, Republic of Korea
| | - Jeongmin Seo
- Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea
| | - Dong Won Kim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Seong Kuk Yoon
- Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Tae-Ho Park
- Department of Cardiology, College of Medicine, Dong-A University, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, Republic of Korea
| | - Ki-Nam Lee
- Department of Radiology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yeonyee Elizabeth Yoon
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Ong P, Aziz A, Hansen HS, Prescott E, Athanasiadis A, Sechtem U. Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris. Circ J 2015; 79:1431-1438. [DOI: 10.1253/circj.cj-15-0520] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Peter Ong
- Department of Cardiology, Robert Bosch Krankenhaus
| | - Ahmed Aziz
- Department of Cardiology, Odense University Hospital
- Department of Cardiology, Robert Bosch Krankenhaus
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen
| | | | - Udo Sechtem
- Department of Cardiology, Robert Bosch Krankenhaus
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Kawaguchi T, Hayashi H, Naiki N, Sakai H, Yamamoto T, Fujita M, Horie M. Spontaneous coronary artery spasm accidentally detected by 320-row multi-detector computed tomography. J Cardiol Cases 2013; 8:e85-e87. [PMID: 30546750 DOI: 10.1016/j.jccase.2013.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/06/2013] [Accepted: 04/15/2013] [Indexed: 11/18/2022] Open
Abstract
A 64-year-old woman was introduced to our hospital suspected of having angina pectoris. A 12-lead electrocardiogram showed negative T wave in inferior leads. An echocardiography revealed no abnormality. In 320-row multi-detector computed tomography (MDCT), a severe narrowing of the right coronary artery was detected with collateral vessels between the distal portion of the obstructed right coronary artery and the left anterior descending artery. Coronary angiography showed no stenosis of the right coronary artery and non-obstructive plaques in the left coronary artery. To provoke coronary artery spasm, acetylcholine was infused into the left coronary artery. But, no narrowing was inducible in the left coronary artery. After that, a spasm of the right coronary artery was observed without the injection of acetylcholine into the right coronary artery. The spasm was located in the same site as the narrowing on MDCT imaging. A calcium channel antagonist (benidipine hydrochloride 8 mg/day) and a nitrate (isosorbide dinitrate 80 mg) were effective for coronary artery spasm. <Learning objective: Multi-detector computed tomography (MDCT) imaging is useful for examining coronary artery disease. In addition to evaluating coronary organic stenosis, 320-row MDCT could detect spontaneous coronary artery spasm. Although coronary artery spasm has to be taken into account, intracoronary injection of acetylcholine is necessary to diagnose coronary artery spasm.>.
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Affiliation(s)
- Tamiro Kawaguchi
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hideki Hayashi
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Nobu Naiki
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hiroshi Sakai
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Takashi Yamamoto
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Masatoshi Fujita
- Department of Cardiovascular Medicine, Uji Hospital, Uji, Kyoto, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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