title: Determinants of Myocardial Lactate Production During Acetylcholine Provocation Test in Patients With Coronary Spasm.
abstract: BACKGROUND
  Myocardial lactate production in the coronary circulation during acetylcholine (ACh)-provocation test (abbreviated as lactate production) provides supporting evidence for coronary spasm-induced myocardial ischemia. The purpose of this study was to examine the clinical features, predictive factors, and prognosis of patients with coronary vasospastic angina (VSA) and lactate production.
  
  
  RESULTS
  We examined all 712 patients who underwent both myocardial lactate measurement during ACh-provocation test in the left coronary artery and genetic screening test of a -786T/C polymorphism in the 5'-flanking region of the endothelial nitric oxide synthase (eNOS) gene between January 1991 and December 2010. Lactate production was observed in 252 of the 712 patients and in 219 of 356 VSA patients diagnosed by ACh-provocation test. Compared with lactate production-negative VSA patients, the lactate production-positive counterparts were more likely to be nonsmoker female diabetics with -786T/C eNOS polymorphism (61% vs 31%, P<0.001, 62% vs 34%, P<0.001, 24% vs 14%, P=0.016, and 25% vs 15%, P=0.018, respectively). Multivariable logistic regression analysis identified female sex, diabetes mellitus, and -786T/C eNOS polymorphism to correlate with lactate production (odds ratio 3.51, 95% CI 2.16 to 5.70, P<0.001; odds ratio 2.53, 95% CI 1.38 to 4.65, P=0.003; and odds ratio 1.85, 95% CI 1.02 to 3.35, P=0.044, respectively). Kaplan-Meier survival curve showed no difference in 5-year survival rate free from major adverse cardiac events between lactate production-positive and -negative VSA patients (P=0.319).
  
  
  CONCLUSIONS
  The results indicated that female sex, diabetes, and mutation in -786T/C eNOS gene correlate with ACh-provoked myocardial ischemia in patients with coronary spasm.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Koji
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakayama
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Arima
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Koichi
authors.initials: K
authors.lastname: Sugamura
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Izumiya
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tsujita
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Megumi
authors.initials: M
authors.lastname: Yamamuro
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Sunao
authors.initials: S
authors.lastname: Kojima
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Soejima
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Seiji
authors.initials: S
authors.lastname: Hokimoto
authors.affiliation: Department of Community Medicine, Kumamoto University Hospital, Kumamoto, Japan (K.M.).
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (K.K., M.I., K.S., M.N., Y.A., T.T., K.S., K.S., Y.I., E.Y., K.T., M.Y., S.K., H.S., S.H., H.O.).
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000378:metabolism; D005260:Female; D006801:Humans; D007773:Lactates / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D052250:Nitric Oxide Synthase Type III / Q000235:genetics*; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D011379:Prognosis; D012307:Risk Factors
chemical_list: D007773:Lactates; D052250:Nitric Oxide Synthase Type III; D000109:Acetylcholine
keywords: acetylcholine‐provocation test; coronary spasm; endothelial nitric oxide synthase polymorphism; myocardial lactate production