Intracoronary focal nitroglycerin injection through drilled balloon is very effective in the resolution of coronary spasm versus into proximal coronary artery: A prospective randomized comparison study

Background: Several cytochrome P450 (CYP) enzyme families have been identified in extra hepatic tissues such as heart, vasculature, kidney, and lung. CYP2C19 localized in vascular smooth muscle and endothelium contributes to the regulation of vascular tone and homeostasis. However, it is unknown whether CYP2C19 genotype is associated with the vascular tonus in patients with VSA. The aim of this study was to examine the impact of CYP2C19 genotype on coronary artery spasm in patients with VSA. Methods: We examined the distribution of CYP2C19 genotype in patients with VSA (n=129) who were diagnosed by intra-coronary acetylcholine infusion test and healthy subjects (n=455) as control group. CYP2C19 genotypes were divided into 3 groups; (1) CYP2C19*1/*1: EM, (2) one loss-of-function allele (*1/*2, *1/*3: IM), and (3) two loss-of-function alleles (*2/*2, *2/*3, *3/*3: PM). Moreover, we measured the level of high-sensitive CRP (hs-CRP) as a degree of low glade inflammation in each group. Results: The ratios of CYP2C19 genotype (EM, IM, and PM) were 30, 42, and 28% in VSA group, and 32, 49, and 19% in control group. In short, PM frequency was significantly higher in VSA than in control (28% vs 19%, P=0.026). In VSA group, the ratios of CYP2C19 genotype were 36, 44, and 20% in male, and 20, 39, and 41% in female, respectively. Briefly, the PM frequency was significantly higher in female than in male (41% vs 20%, P<0.001). Moreover, the level of hs-CRP was significantly higher in VSA group than in control group (0.17±0.367 vs 0.10.±0.240, P=0.02). When patients were stratified by gender, the level of hs-CRP was significantly higher in VSA group in female (0.11±0.198 vs 0.06±0.105, P=0.031) and male (0.20±0.438 vs 0.12±0.277, P=0.044). Multivariate analysis for coronary spasm indicated high age, hypertension, and high level of hs-CRP as predictive factors among all subjects. PM is a predictive factor for coronary spasm in female group only (OR3.1, 95%RI 1.525-6.317, P=0.002), but not in male (OR0.829, 95%RI 0.453-1.518, P=0.543). Conclusion: The CYP2C19 two loss-of-function alleles (PM) and low grade inflammation may be associated with pathophysiology of coronary artery spasm and the regulation of coronary tonus, especially in female.

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Smooth muscles from spastic coronary artery segments show hypercontractility to histamine

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1990.259.1.h9 ◽

1990 ◽

Vol 259 (1) ◽

pp. H9-H13 ◽

Cited By ~ 2

Author(s):

S. Satoh ◽

H. Tomoike ◽

W. Mitsuoka ◽

S. Egashira ◽

H. Tagawa ◽

...

Keyword(s):

Smooth Muscle ◽

Coronary Artery ◽

Coronary Arteries ◽

Muscle Fibers ◽

Coronary Spasm ◽

Smooth Muscles ◽

Bolus Administration ◽

Luminal Diameter ◽

Endothelial Denudation ◽

Significant Difference

An animal model of coronary spasm was produced in Gottingen miniature pigs by a selective endothelial denudation of the coronary artery. Five months after the denudation, intracoronary bolus administration of 10 micrograms/kg histamine reduced the luminal diameter angiographically by 57 +/- 16 and 17 +/- 10% (P less than 0.01) in the previously denuded and contralateral control coronary arteries. Muscle fibers of 0.08–0.1 mm wide were prepared from circumferential bundles of the medial smooth muscle in the spastic and nonspastic coronary arteries. Upward shifts of either dose-tonic contraction relationships in Ca2(+)-containing solution or dose-monophasic contraction relationships in Ca2(+)-free solution were noted in muscle fibers taken from the spastic site compared with those from the nonspastic site with no difference between the mean effective dose values. After skinning the muscle fibers with saponin, there was no significant difference in the Ca2+ concentration-tension relationships between the two fibers. These findings suggest that an increased number of histaminergic receptors and/or augmentation of signal transduction, but not Ca2+ sensitivity of the contractile proteins in the medial smooth muscle cells, cause histamine-induced coronary hypercontraction.

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PP-007 Diffuse Coronary Spasm Mimicking the Severe Coronary Artery Stenosis to Rule out with Intravascular Ultrasound

The American Journal of Cardiology ◽

10.1016/j.amjcard.2015.01.363 ◽

2015 ◽

Vol 115 ◽

pp. S97

Author(s):

Cengiz Ozturk ◽

Mustafa Aparci ◽

Ali Osman Yıldırım ◽

Sait Demirkol ◽

Murat Unlu ◽

...

Keyword(s):

Coronary Artery ◽

Intravascular Ultrasound ◽

Coronary Artery Stenosis ◽

Coronary Spasm ◽

Artery Stenosis ◽

Severe Coronary Artery ◽

Rule Out

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Relation of microcirculatory thrombosis to thrombus in the proximal coronary artery: Effect of aspirin, dipyridamole, and thrombolysis

American Heart Journal ◽

10.1016/0002-8703(73)90010-0 ◽

1973 ◽

Vol 86 (1) ◽

pp. 61-68 ◽

Cited By ~ 59

Author(s):

Christos B. Moschos ◽

Kamalesh Lahiri ◽

Michael Lyons ◽

Allen B. Weisse ◽

Henry A. Oldewurtel ◽

...

Keyword(s):

Coronary Artery ◽

Proximal Coronary Artery

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COVID-19 Pneumonia with Atrial Fibrillation, Coronary Spasm, and Wavy Triple Sign (Yasser’s Sign); Dramatic Reversal at Home Management

Edelweiss Journal of Biomedical Research and Review ◽

10.33805/2639.6807.130 ◽

2021 ◽

pp. 20-23

Author(s):

Yasser Mohammed Hassanain Elsayed

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Coronary Artery Spasm ◽

Coronary Spasm ◽

Initial Therapy ◽

Good Prognosis ◽

Elderly Male ◽

St Segment

Rationale: A novel COVID-19 with a severe acute respiratory syndrome or pneumonia had arisen in Wuhan, China in December 2019. Emerging atrial fibrillation in COVID-19 patients is highly significant in cardiovascular medicine. A newly coronary artery spasm in the presentation of COVID-19 infection has certainly a risk impact on both morbidity and mortality of COVID-19 patients. Wavy triple an electrocardiographic sign (Yasser Sign) is an innovated sign of hypocalcaemia linked to tachypnea and acute respiratory distress. Patient concerns: An elderly male COVID-19 patient presented to physician outpatient clinic with bilateral pneumonia, atrial fibrillation, evidence of coronary artery spasm, and Wavy triple an electrocardiographic sign (Yasser Sign). Diagnosis: COVID-19 pneumonia with coronary artery spasm and the Wavy triple an electrocardiographic sign (Yasser Sign). Interventions: Chest CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: The reversal of electrocardiographic ST-segment depressions in a COVID-19 patient after adding oral nitroglycerine is an indicator for the presence of coronary artery spasm. It signifies the role of the anti-infective drugs, anticoagulants, antiplatelet, and steroids in COVID-19 patients with bilateral pneumonia, AF, coronary artery spasm are effective therapies. The disappearance of AF after initial therapy may a guide for a good prognosis in this case study. The evanescence of Wavy triple ECG sign as a hallmark for the existence of the Movable-weaning phenomenon of hypocalcaemia is recommended for further wide-study.

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Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis with ECG change mimicking acute non-ST-segment elevation myocardial infarction: A case report

10.21203/rs.2.24315/v1 ◽

2020 ◽

Author(s):

Fan-xin Kong ◽

Meng Li ◽

Chun-Yan Ma ◽

Ping-ping Meng ◽

Yong-huai Wang ◽

...

Keyword(s):

Myocardial Infarction ◽

Differential Diagnosis ◽

Coronary Artery ◽

Troponin I ◽

Hypereosinophilic Syndrome ◽

Coronary Spasm ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment

Abstract Background Loeffler’s endocarditis is an inflammatory cardiac condition of hypereosinophilic syndrome which rarely involves coronary artery. When coronary artery is involved, known as eosinophilic coronary periarteritis, the clinical presentation, electrocardiographic changes and troponin level are extremely nonspecific and may mimic acute coronary syndrome. It is very important to make differential diagnosis for ECPA in order to avoid the unnecessary further invasive coronary angiography. Case presentation We report a case with chest pain, ST-segment depression in electrocardiogram and increased troponin-I mimicking acute non-ST-segment elevation myocardial infarction. However, quick echocardiography showed endomyocardial thickening with normal regional wall motion, which corresponded to the characteristics of Loeffler’s endocarditis. Emergent blood analysis showed marked increase in eosinophils and computed tomography angiography found no significant stenosis of coronary artery. Manifestations of magnetic resonance imaging consisted with findings of echocardiography. Finally, the patient was diagnosed as Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis. Conclusion This case exhibits the crucial use of quick transthoracic echocardiography and the emergent hematological examination for differential diagnosis in such scenarios as often if electrocardiogram change mimicking myocardial infarction.

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Vasoconstrictor effect of endothelin on the canine coronary artery: Is a novel endogenous peptide involved in regulating myocardial blood flow and coronary spasm?

American Heart Journal ◽

10.1016/0002-8703(89)90578-4 ◽

1989 ◽

Vol 118 (4) ◽

pp. 674-678 ◽

Cited By ~ 28

Author(s):

Yutaka Igarashi ◽

Yoshifusa Aizawa ◽

Makoto Tamura ◽

Katsuya Ebe ◽

Yamaguchi Toshio ◽

...

Keyword(s):

Blood Flow ◽

Coronary Artery ◽

Myocardial Blood Flow ◽

Coronary Spasm ◽

Endogenous Peptide ◽

Vasoconstrictor Effect ◽

Canine Coronary Artery

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Abstract 915: The Effect of Gender and Race on Outcomes in Patients Undergoing PCI for Proximal Coronary Artery Lesions: A Report from the NHLBI Dynamic Registry of PCI

Circulation ◽

10.1161/circ.118.suppl_18.s_632 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Sandy M Green ◽

Faith Selzer ◽

Suresh Mulukutla ◽

Ashley Lee ◽

Lee S Joon ◽

...

Keyword(s):

Coronary Artery ◽

Female Gender ◽

Adverse Outcomes ◽

High Risk Population ◽

Gender And Race ◽

Repeat Revascularization ◽

Coronary Artery Segment ◽

Artery Segment ◽

Coronary Lesions ◽

Proximal Coronary Artery

Background: Little is known about the effect of gender and race on outcomes in patients after revascularization of proximal coronary lesions (PCL). We investigated their effect on outcomes using the NHLBI Dynamic Registry. Methods: Of the 9962 patients receiving PCI, 3918 (39%) were treated for disease in a proximal coronary artery segment. Left main and PCI for graft lesions were excluded. Primary outcomes were death/MI or need for repeat revascularization at 1 year after the index procedure. Results: 80% of the patients were white (n=3144), 11% black (n=469), 63% male (n=2461), and 37% female (n=1457). Patients with PCL had lower rates of HTN, prior MI, but where older and had more concomitant medical disease. Compared to non-proximal lesions, patients with PCL had higher rate of death (5.4% vs. 4%, p=0.001) and repeat revascularization (16.3% vs. 14.3%, p=0.01). The effect of gender and race were then included in the multivariate model for predicting risk in patients with PCL (Table 1 ). Race did not modify the risk associated with PCL but females had a 32% greater relative risk (p=0.002) of repeat revascularization when compared to men. Conclusions: Treatment of proximal coronary lesions is associated with a more adverse outcomes compared to non-proximal coronary lesions. In this high-risk population, female gender is an independent predictor for the need for repeat revascularization. Table 1: Event rates, unadjusted and adjusted hazard ratios and 95% confidence intervals in patients undergoing proximal vessel PCI

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