Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries

• Published in: Clinical research in cardiology Vol. 109; no. 4; pp. 435 - 443
• Main Authors: Montone, Rocco Antonio, Niccoli, Giampaolo, Russo, Michele, Giaccari, Marta, Del Buono, Marco Giuseppe, Meucci, Maria Chiara, Gurgoglione, Filippo, Vergallo, Rocco, D’Amario, Domenico, Buffon, Antonino, Leone, Antonio M., Burzotta, Francesco, Aurigemma, Cristina, Trani, Carlo, Liuzzo, Giovanna, Lanza, Gaetano A., Crea, Filippo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2020; Springer Nature B.V
• Subjects: Acetylcholine - administration & dosage; Aged; Angina; Angina pectoris; Angiography; Arteries; Arteriosclerosis; Atherosclerosis; Cardiology; Cardiovascular disease; Coronary Angiography; Coronary artery; Coronary artery disease; Coronary Circulation; Coronary Vasospasm - diagnostic imaging; Coronary Vasospasm - physiopathology; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Echocardiography, Doppler, Pulsed; Female; Health risk assessment; Heart diseases; Humans; Ischemia; Male; Males; Medical imaging; Medicine; Medicine & Public Health; Microcirculation; Microvasculature; Middle Aged; Myocardial infarction; Myocardial Ischemia - diagnostic imaging; Myocardial Ischemia - physiopathology; Necrosis; Original Paper; Patients; Predictive Value of Tests; Prospective Studies; Regression analysis; Smoking; Vasoconstriction; MINOCA; Microvascular spasm; Epicardial spasm; Provocative test
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-019-01523-w

Background
Coronary vasomotor dysfunction represents an important mechanism responsible for myocardial ischaemia in patients with non-obstructive coronary artery disease (CAD). The use of invasive provocative tests allows identifying patients with epicardial or microvascular spasm. Of note, clinical characteristics associated with the occurrence of epicardial or microvascular spasm have still not completely clarified.
Methods and results
We prospectively enrolled consecutive patients undergoing coronary angiography for suspected myocardial ischaemia/necrosis with evidence of non-obstructive CAD and undergoing intracoronary provocative test for suspected vasomotor dysfunction. Patients with a positive provocative test were enrolled. Clinical, echocardiographic and angiographic characteristics of patients were evaluated according to the pattern of vasomotor dysfunction (epicardial vs. microvascular spasm). We included 120 patients [68 patients with stable angina and 52 patients with myocardial infarction and non-obstructive coronary arteries (MINOCA)]. In particular, 77 (64.2%) patients had a provocative test positive for epicardial spasm and 43 (35.8%) patients for microvascular spasm. Patients with epicardial spasm were more frequently males, smokers, had higher rates of diffuse coronary atherosclerosis at angiography and more frequently presented with MINOCA. On the other hand, patients with microvascular spasm presented more frequently diastolic dysfunction. At multivariate logistic regression analysis male sex, smoking, and diffuse coronary atherosclerosis were independent predictors for the occurrence of epicardial spasm.
Conclusions
Our study showed that specific clinical features are associated with different responses to intracoronary provocative test. Epicardial spasm is more frequent in males and in MINOCA patients, whereas microvascular spasm is more frequent in patients with stable angina and is associated with diastolic dysfunction.