Association of plasma level of malondialdehyde-modified low-density lipoprotein with coronary plaque morphology in patients with coronary spastic angina: implication of acute coronary events.
BACKGROUND
Focal vasospasm is reportedly involved in a high incidence of acute coronary syndrome (ACS) as compared with diffuse vasospasm. No adequate studies have been conducted on the mechanism underlying the higher incidence of ACS involving focal vasospasm than of those involving diffuse vasospasm in patients with coronary spastic angina.


RESULTS
Blood samples were collected from the aortic root (Ao) and the coronary sinus (CS) before provoking left coronary vasospasm using intracoronary administration of acetylcholine. After relief of vasospasm, volumetric analyses of vasospastic lesions were evaluated with 3-dimensional intravascular ultrasound in 64 patients. The percent plaque volume was more prominent in focal (n=31) than in diffuse vasospasm (n=33) (40.9+/-9.4 vs. 23.3+/-9.2%, p<0.0001). The Cs-Ao difference of malondialdehyde-modified low-density lipoprotein (MDA-LDL) level, as a marker of atherothrombosis, in focal vasospasm increased significantly as compared with diffuse vasospasm (6.9+/-6.7 vs. 1.2+/-5.7 U/L, p=0.001). In a multiple-logistic regression analysis with the traditional risk factors, the Cs-Ao difference of MDA-LDL level was a variable differing independently between the 2 types of vasospasm.


CONCLUSIONS
Higher MDA-LDL levels were observed in the coronary circulation in patients with focal vasospasm than in those with diffuse vasospasm. Under these conditions, the dramatically increased percent plaque volume in cases with focal vasoconstriction may play an important role in the development of acute coronary events.
Tani
Shigemasa
S
Department of Cardiology, Nihon University Surugadai Hospital, Tokyo Japan. tanishigem@yahoo.co.jp
Nagao
Ken
K
Anazawa
Takeo
T
Kawamata
Hirofumi
H
Furuya
Shingo
S
Fuji
Takeshi
T
Takahashi
Hiroshi
H
Iida
Kiyoshi
K
Matsumoto
Michiaki
M
Kumabe
Takamichi
T
Sato
Yuichi
Y
Hirayama
Atsushi
A
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D000368:Aged; D001011:Aorta; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D054326:Coronary Sinus; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D006801:Humans; D015994:Incidence; D008077:Lipoproteins, LDL / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008315:Malondialdehyde / Q000097:blood*; D008875:Middle Aged; D012307:Risk Factors; D018084:Ultrasonography, Interventional
D008077:Lipoproteins, LDL; D008315:Malondialdehyde