title: Severity of myocardial fatty acid dysmetabolism induced by coronary spasm does not differ with Thrombolysis in Myocardial Infarction (TIMI) grade during intracoronary acetylcholine provocation tests.
abstract: Whether additional intracoronary acetylcholine (ACH) injections are required for severe coronary spasm without limited coronary flow in the ACH provocation test remains unclear. We used (123)I-β-methyl-iodophenyl pentadecanoic acid ((123)I-BMIPP) to identify myocardial ischemic memory to compare the severity of myocardial fatty acid dysmetabolism among Thrombolysis in Myocardial Infarction (TIMI) grade flow.Thirteen hypertensive volunteers (mean age, 69.5 years) and 37 patients with VSA (mean age, 62.8 years) were enrolled. The patients with VSA were stratified according to TIMI flow grades of 3 (90% luminal narrowing; n = 12) or TIMI 0-2 (≥ 99% or total occlusion; n = 25) during ACH provocation tests. Two weeks after cardiac catheterization, (123)I-BMIPP myocardial scintigraphic images were obtained at 15 minutes (early) and at 4 hours (delayed) after tracer injection. The heart-to-mediastinum (H/M) ratio and washout rates (WR) were calculated from planar images.The TIMI 3 and TIMI 0-2 groups had significantly lower early and delayed H/M ratios than controls but the difference did not reach significance between the two groups (Early: 2.7 ± 0.5 versus 2.3 ± 0.4 and 2.2 ± 0.3, P = 0.024; Delayed: 2.4 ± 0.4 versus 1.8 ± 0.3 and 1.8 ± 0.3, P = 0.001). The washout rate was greater for TIMI 0-2 than the controls.The severity of myocardial fatty acid dysmetabolism did not differ between TIMI 3 and TIMI 0-2 coronary spasms. Additional ACH might not be required considering safety and the severity of coronary spams with TIMI 3 grade flow.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine.
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.forename: Yoshihiro J
authors.initials: YJ
authors.lastname: Akashi
authors.forename: Kohei
authors.initials: K
authors.lastname: Ashikaga
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kida
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sato
authors.forename: Maya
authors.initials: M
authors.lastname: Tsukahara
authors.forename: Marika
authors.initials: M
authors.lastname: Yamada
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.forename: Ryo
authors.initials: R
authors.lastname: Kamijima
authors.forename: Kengo
authors.initials: K
authors.lastname: Suzuki
authors.forename: Haruki
authors.initials: H
authors.lastname: Musha
authors.forename: Tomoo
authors.initials: T
authors.lastname: Harada
mesh_terms: D000109:Acetylcholine / Q000008:administration & dosage; D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D003329:Coronary Vasospasm / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D003331:Coronary Vessels; D004734:Energy Metabolism; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D009206:Myocardium / Q000378:metabolism*; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D005227:Fatty Acids; D014665:Vasodilator Agents; D000109:Acetylcholine