Diagnosis of Multivessel Coronary Vasospasm by Detecting Postischemic Regional Left Ventricular Delayed Relaxation on Echocardiography Using Color Kinesis
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概要
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Background It is not known whether multivessel coronary spasm occurs spontaneously in patients who have variant angina (VA) with demonstrated multivessel spasm induced by intracoronary injection of acetylcholine (ACh). Regional left ventricular (LV) diastolic dysfunction or wall motion abnormality may persist after an episode of coronary vasospasm. Color kinesis (CK) is a recent development that facilitates the echocardiographic evaluation of regional diastolic wall motion. Methods and Results Regional diastolic wall motion was evaluated using CK in 26 patients with VA within 1 week of the last episode of angina. The LV segmental filling fraction in the short-axis view during the first 30% of the diastolic filling time, expressed as a percentage, was used to objectively identify postischemic diastolic endocardial motion asynchrony. Diastolic asynchrony or regional LV delayed relaxation was noted in all 26 (100%) patients and in 14 (54%) it was detected in multiple vascular territories, suggesting multivessel spasm. Multivessel spasm was induced by ACh in 11 (79%) of the patients with suspected multivessel spasm by CK. In 11 (92%) of the 12 patients with multivessel spasm induced by ACh multiple regions of delayed relaxation hadbeen noted by CK. The regions of delayed relaxation were largely consistent with the territories perfused by the arteries reacting to ACh (sensitivity: 96%, specificity: 91 %). Conclusion ACh induced spasm in the same coronary arteries as those perfusing the regions with delayed diastolic wall motion detected by CK in most of the patients with VA, suggesting that multivessel spasm does occur spontaneously in patients with susceptible arteries.
- 社団法人日本循環器学会の論文
- 2004-04-20
著者
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Okuda Nobuaki
Cardiovascular Division Kansai Electric Power Hospital
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Ishii Katsuhisa
Cardiovascular Division Kansai Electric Power Hospital
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Miwa Kunihisa
Division of Medicine, Hamamatsu Rosai Hospital, Shizuoka
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Makita Toshinori
Cardiovascular Division, Kansai Electric Power Hospital
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Miwa Kunihisa
Second Department of Internal Medicine, Kansai Electric Power Hospital
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Ishii Katsuhisa
Second Department of Internal Medicine, Kansai Electric Power Hospital
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Makita Toshinori
Second Department of Internal Medicine, Kansai Electric Power Hospital
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Okuda Nobuaki
Second Department of Internal Medicine, Kansai Electric Power Hospital
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Miwa Kunihisa
Division Of Medicine Hamamatsu Rosai Hospital Shizuoka
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Miwa Kunihisa
Second Department Of Internal Medicine Faculty Of Medicine Toyama Medical And Pharmaceutical Univers
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Makita Toshinori
Cardiovascular Division Kansai Electric Power Hospital
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