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Erschienen in: Clinical Research in Cardiology 12/2019

29.03.2019 | Original Paper

Coronary microvascular dysfunction in patients with acute coronary syndrome and no obstructive coronary artery disease

verfasst von: Antonio De Vita, Laura Manfredonia, Priscilla Lamendola, Angelo Villano, Salvatore Emanuele Ravenna, Antonio Bisignani, Giampaolo Niccoli, Gaetano Antonio Lanza, Filippo Crea

Erschienen in: Clinical Research in Cardiology | Ausgabe 12/2019

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Abstract

Background

Between 10 and 15% of patients admitted for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) show no obstructive coronary artery disease (NO-CAD) at angiography. Coronary microvascular spasm is a possible mechanism of the syndrome, but there are scarce data about coronary microvascular function in these patients.

Objectives

To assess coronary microvascular function in patients with NSTE-ACS and NO-CAD.

Methods

We studied 30 patients (67 ± 10 years, 19 female) with NSTE-ACS and NO-CAD. Specific causes of NSTE-ACS presentation (e.g., variant angina, takotsubo disease, tachyarrhythmias, etc.) were excluded. Coronary blood flow (CBF) velocity response to IV ergonovine (6 µg/kg up to a maximal dose of 400 µg) was evaluated before discharge by transthoracic Doppler echocardiography. CBF response to IV adenosine (140 μg/kg/min) and cold pressor test (CPT) was also assessed after 1 month. Ten age- and sex-matched patients with non-cardiac chest pain served as controls. Vasoactive tests were repeated after 12 months in 10 NSTE-ACS patients.

Results

The ergonovine/basal CBF velocity ratio was 0.79 ± 0.09 and 0.99 ± 0.01 in patients and controls, respectively (p < 0.001). The adenosine/basal CBF velocity ratio was 1.46 ± 0.2 and 3.25 ± 1.2 in patients and controls, respectively (p < 0.001), and the CPT/basal CBF velocity ratio was 1.36 ± 0.2 and 2.43 ± 0.3 in the 2 groups, respectively (p < 0.001). In 10 patients assessed after 12 months, CBF velocity responses to ergonovine, adenosine, and CPT were found to be unchanged.

Conclusions

Patients with NSTE-ACS and NO-CAD exhibit a significant coronary dysfunction, which seems to involve both an increased constrictor reactivity, likely mainly involving coronary microcirculation, and a reduced microvascular dilator function, both persisting at 12-month follow-up.
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Metadaten
Titel
Coronary microvascular dysfunction in patients with acute coronary syndrome and no obstructive coronary artery disease
verfasst von
Antonio De Vita
Laura Manfredonia
Priscilla Lamendola
Angelo Villano
Salvatore Emanuele Ravenna
Antonio Bisignani
Giampaolo Niccoli
Gaetano Antonio Lanza
Filippo Crea
Publikationsdatum
29.03.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Research in Cardiology / Ausgabe 12/2019
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-019-01472-4

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