title: Increased circulating malondialdehyde-modified low-density lipoprotein levels in patients with ergonovine-induced coronary artery spasm.
abstract: OBJECTIVE
  Coronary endothelial dysfunction is thought to underlie the development of coronary artery spasms. Malondialdehyde-modified low-density lipoprotein (MDA-LDL) was suggested as a marker of endothelial damage. This study investigated the diagnostic impact of MDA-LDL on ergonovine-induced coronary spasms.
  
  
  METHODS
  We included 152 patients with suspected coronary spastic angina. MDA-LDL levels were measured before an ergonovine provocation test. Coronary spasm was defined as total or subtotal occlusion, compared to the relaxed state after nitroglycerin, associated with ischemic ECG changes and concurrent chest pain. Changes in vessel diameter in response to ergonovine were evaluated with quantitative coronary angiography.
  
  
  RESULTS
  Coronary spasms were observed in 41 patients (27%). MDA-LDL levels were significantly higher in patients with spasms compared to those without spasms (139.9 ± 45.9 U/L vs. 109.6 ± 36.6 U/L, p<0.01). Univariate logistic regression analyses indicated significant relationships between coronary spasms and MDA-LDL (per 10 U/L, odds ratio (OR): 1.20; p<0.01), high-density lipoprotein (per 10 mg/dL, OR: 0.76; p=0.03), smoking (OR: 3.04; p<0.01), and male gender (OR: 3.51; p<0.01). In the multivariate model, MDA-LDL (per 10 U/L, OR: 1.17; p<0.01) remained a significant predictor of coronary spasm. Regression analysis showed a positive correlation between MDA-LDL levels and coronary luminal diameter changes induced by ergonovine (r=0.57, p<0.01). The optimal MDA-LDL threshold for predicting coronary spasm was 121.3 U/L, identified with a receiver operating characteristic curve.
  
  
  CONCLUSIONS
  Increased circulating MDA-LDL levels were associated with ergonovine-induced coronary artery spasm.
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: tuyosiito@gmail.com.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujita
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Tani
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ohte
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000494:pharmacology; D017023:Coronary Angiography / Q000379:methods; D003329:Coronary Vasospasm / Q000503:physiopathology*; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000187:drug effects*; D004874:Ergonovine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008315:Malondialdehyde / Q000494:pharmacology*; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology*; D013223:Statistics as Topic
chemical_list: D002317:Cardiovascular Agents; D008077:Lipoproteins, LDL; D008315:Malondialdehyde; D005996:Nitroglycerin; D004874:Ergonovine
keywords: Coronary spasm; Ergonovine; Malondialdehyde-modified low-density lipoprotein