缺乏用于诊断冠状动脉痉挛患者的 I 级血管活性测试。

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2024-08-28 DOI:10.1002/clc.70004

Shozo Sueda, Yutaka Hayashi, Hiroki Ono, Hikaru Okabe, Tomoki Sakaue, Shuntaro Ikeda

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引用次数: 0

摘要

背景：根据冠状动脉血管运动障碍国际研究（COVADIS）小组的建议和日本循环学会（JCS）的指南，血管活性测试，如冠状动脉内乙酰胆碱（ACh）或麦角新碱（EM），被定义为诊断血管痉挛性心绞痛（VSA）患者的I级测试：假设：虽然血管反应性测试是一种临床有用的工具，但它在诊断冠状动脉痉挛方面存在一定的风险和局限性：方法：从 I 级的角度总结了以往关于血管反应性测试诊断冠状动脉痉挛的报告：结果：与日常痉挛相关的几个问题，如可重复性、低估、高估和不确定/非特异性结果。由于冠状动脉内 ACh 引起的激惹性痉挛与冠状动脉内 EM 引起的激惹性痉挛并不总是相似的，这可能是由于介质不同所致，因此，当每种血管活性剂都不能显示出激惹性痉挛时，心脏病专家有必要辅助使用这些血管活性测试来诊断 VSA：结论：心脏病专家在诊断 VSA 患者时应了解这些血管活性测试的不完善之处。

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Lack of Class I Vasoreactivity Testing for Diagnosing Patients With Coronary Artery Spasm

Background

Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS).

Hypothesis

Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm.

Methods

Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I.

Results

There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent.