Skip to main content
SpringerLink
Log in

A long-acting calcium antagonist over one year did not improve BMIPP myocardial scintigraphic imagings in patients with pure coronary spastic angina

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Background: Calcium antagonists (Ca) have been effective in reducing angina attacks in patients with variant angina. However, there are no reports regarding the effectiveness of Ca on myocardial fatty acid metabolic images in patients with pure coronary spastic angina (CSA).Objectives: This study sought to examine the correlation between myocardial fatty acid metabolic images and the medical treatment of Ca in patients with pure CSA.Methods and Results: This study included 35 consecutive patients (28 men, mean age of 66±10 years) with angiographically confirmed coronary spasm and no fixed stenosis. Long-acting Ca was administered to all 35 patients. Isosorbide dinitrate /nicorandil/another Ca/beta-bloker were administered when chest pain was not controlled. Using an iodinated fatty acid analogue, 15-(p-[iodine-123]iodophenyl)-3-(R,S)methylpentadecanoic acid (BMIPP), myocardial scintigraphies with intravenous adenosine triphosphate infusion were performed before cardiac catheterization and 12 mo after medical therapy. According to the medical control states, these 35 patients were classified into 3 groups; response (disappearance of angina attacks, 12 pts, 60±11 years), partial response (angina attacks <4/mo, 12 pts, 67±10 years), and no response to therapy (angina attacks ≥4/mo, 11 pts, 71±6 years). Reduced BMIPP uptake was observed in 24 (69%) of 35 patients before the treatment. Reduced BMIPP uptake was also found in 18 patients (51%) after 12 mo. Normal BMIPP uptake after 12 mo therapy was observed in about half (response: 42%, partial response: 58%, no response: 45%) of patients among the 3 groups. There was no difference regarding the value of washout rate (WOR) (response; 10±7 (before), 14 ±8% (12 mo)), partial response; 11±7, 10±5%, no response; 13±9, 14±8%) among the 3 groups. The defect scores of BMIPP in the three groups were not different during at least one year medical therapy. No difference regarding the distribution of other medical therapies (angiotensin converting enzyme inhibitors/angiotensin receptor blockers/beta-blockers/statins) was found. The administration of Ca and isosorbide dinitrate/nicorandil and 2 Ca was significantly higher in the poor than in the good control patients.Conclusions: Long-acting Ca over one year did not improve myocardial fatty acid metabolic images in patients with pure CSA. This may be related to silent ischemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Feldman RL, Pepine CJ, Whittle J, Conti CR. Short- and long-term responses to diltiazem in patients with variant angina.Am J Cardiol 1982; 49: 554–559.

    Article  PubMed  CAS  Google Scholar 

  2. Freedman SB, Richmond DR, Kelly DT. Long-term follow-up of verapamil and nitrate treatment for coronary artery spasm.Am J Cardiol 1982; 50: 711–715.

    Article  PubMed  CAS  Google Scholar 

  3. Johnson SM, Mauritson DR, Willerson JT, Hillis LD. A controlled trial of verapamil for Prinzmetal's variant angina.N Eng J Med 1981; 304: 862–866.

    CAS  Google Scholar 

  4. Prida XE, Gelman JS, Feldman RL, Hill JA, Pepine CJ, Scott E. Comparison of diltiazem and nifedipine and in combination in patients with coronary artery spasm.J Am Coll Cardiol 1987; 9: 412–419.

    PubMed  CAS  Google Scholar 

  5. Sueda S, Kohno H, Fukuda H, Uraoka T. Did the widespread use of long-acting calcium antagonists decrease the occurrence of variant angina?.Chest 2003; 124: 2074–2078.

    Article  PubMed  CAS  Google Scholar 

  6. Sueda S, Kohno H, Fukuda H, Watanabe K, Ochi N, Kawada H, et al. Limitations of medical therapy in patients with pure coronary spastic angina.Chest 2003; 123: 380–386.

    Article  PubMed  Google Scholar 

  7. Nakajima K, Shimizu K, Taki J, Uetani Y, Konishi S, Tonami N, et al. Utility of iodine-123-BMIPP in the diagnosis and follow-up of vasospastic angina.J Nucl Med 1995; 36: 1934–1940.

    PubMed  CAS  Google Scholar 

  8. Kawai Y, Tsukamoto E, Nozaki Y, Morita K, Sakurai M, Tamaki N. Significance of reduced uptake of iodinated fatty acid analogue for the evaluation of patients with acute chest pain.J Am Coll Cardiol 2001; 38: 1888–1894.

    Article  PubMed  CAS  Google Scholar 

  9. Tamaki N, Kawamoto M, Yonekura Y, Fujibayashi Y, Magata Y, Torizuka T, et al. Assessment of fatty acid metabolism using I-123 branched fatty acid: Comparison with positron emission tomography.Ann Nucl Med 1993; 7: SII-41–SII-47.

    Google Scholar 

  10. Miyagawa M, Kumano S, Sekiya M, Watanabe K, Akutsu H, Imachi T, et al. Thallium-201 myocardial tomography with intravenous infusion of adenosine triphosphate in diagnosis of coronary artery disease.J Am Coll Cardiol 1995; 26: 1196–1201.

    Article  PubMed  CAS  Google Scholar 

  11. Rozanski A, Berman DS, Gray R, Levy R, Raymond M, Maddahi J, et al. Use of thallium-201 redistribution scintigraphy in the preoperative differentiation of reversible and nonreversible myocardial asynergy.Circulation 1981; 64: 936–944.

    PubMed  CAS  Google Scholar 

  12. Sueda S, Ochi N, Kawada H, Matsuda S, Hayashi Y, Tsuruoka T, et al. Frequency of provoked coronary vasospasm in patients undergoing coronary arteriography with spasm provocation test of acetylcholine.Am J Cardiol 1999; 83: 1186–1190.

    Article  PubMed  CAS  Google Scholar 

  13. Sueda S, Saeki H, Otani T, Mineoi K, Kondou T, Yano K, et al. Major complications during spasm provocation tests with an intracoronary injection of acetylcholine.Am J Cardiol 2000; 85: 391–394.

    Article  PubMed  CAS  Google Scholar 

  14. Sueda S, Fukuda H, Watanabe K, Ochi N, Kawada H, Hayashi Y, et al. Clinical characteristics and possible mechanism of paroxysmal atrial fibrillation induced by intracoronary injection of acetylcholine.Am J Cardiol 2001; 88: 570–573.

    Article  PubMed  CAS  Google Scholar 

  15. Sueda S, Ochi T, Yano K, Mineoi K, Kondou T, Ochi N, et al. New combined spasm provocation test in patients with rest angina: Intracoronary injection of acetylcholine after intracoronary administration of ergonovine.Jpn Circ J 2000; 64: 559–565.

    Article  PubMed  CAS  Google Scholar 

  16. Sueda S, Fukuda H, Watanabe K, Ochi N, Kawada H, Hayashi Y, et al. Usefulness of accelerated exercise following mild hyperventilation for the induction of coronary artery spasm: comparison with an acetylcholine test.Chest 2001; 119: 155–162.

    Article  PubMed  CAS  Google Scholar 

  17. Sueda S, Suzuki J, Watanabe K, Ochi N, Hayashi Y, Kawada H, et al. New non-invasive protocol for detection of coronary spastic angina with significant organic stenosis.Coron Artery Dis 2001; 12: 295–303.

    Article  PubMed  CAS  Google Scholar 

  18. Sueda S, Kohno H, Fukuda H, Inoue K, Suzuki J, Watanabe K, et al. Clinical and Angiographical Characteristics of Acetylcholine Induced-Spasm: Relation to Dose of Intracoronary Injection of Acetylcholine.Coron Artery Dis 2002; 13: 231–236.

    Article  PubMed  Google Scholar 

  19. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffth LSC, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc committee for grading of coronary artery disease, council on cardiovascular surgery, American Heart Association.Circulation 1975; 51 (4): 5–40.

    PubMed  CAS  Google Scholar 

  20. Watanabe K, Sekiya M, Tsuruoka T, Funada J, Miyagawa M. Usefulness of123I-BMIPP with myocardial imaging for evaluation of the efficacy of drug therapy in patients with chronic heart failure.J Card Fail 2001; 7: 257–263.

    Article  PubMed  CAS  Google Scholar 

  21. Fukuzawa S, Ozawa S, Inagaki M, Sugioka J, Daimon M, Kushida S. Angiotensin-converting enzyme inhibitor therapy affects myocardial fatty acid metabolism after acute myocardial infarction.J Nucl Cardiol 2000; 7: 23–28.

    Article  PubMed  CAS  Google Scholar 

  22. Kadokami T, Egashira K, Kuwata K. Altered serotonin receptor subtypes mediate coronary microvascular hyperreactivity in pigs with chronic inhibition of nitric oxide synthesis.Circulation 1996; 94: 182–189.

    PubMed  CAS  Google Scholar 

  23. Sun H, Mohri M, Shimokawa H, Usui M, Urakami L, Takeshita A. Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina.J Am Coll Cardiol 2002; 39: 847–851.

    Article  PubMed  Google Scholar 

  24. Waters DD, Bouchard A, Theroux P. Spontaneous remission is a frequent outcome of variant angina.J Am Coll Cardiol 1983; 2: 195–199.

    Article  PubMed  CAS  Google Scholar 

  25. Bott-Silverman C, Heupler FA. Natural history of pure coronary artery spasm in patients treated medically.J Am Coll Cardiol 1983; 2: 200–205.

    PubMed  CAS  Google Scholar 

  26. Ozaki Y, Takatsu F, Osugi J, Sgiishi M, Watarai M, Anno T, et al. Long-term study of recurrent vasospastic angina using coronary angiograms during ergonovine tests.Am Heart J 1992; 123: 1191–1198.

    Article  PubMed  CAS  Google Scholar 

  27. Ozaki Y, Keane D, Serruys PW. Progression and regression of coronary stenosis in the long-term follow-up of vasosapstic angina.Circulation 1995; 92: 2446–2456.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Saiseikai Saijo Hospital, Tsuitachi 269-1, 793-0027, Saijo, Ehime, Japan

    Shozo Sueda, Akira Oshita, Yousuke Izoe, Hiroaki Kohno & Hiroshi Fukuda

  2. Department of Cardiology, Takanoko Hospital, Takanoko, Japan

    Takaaki Ochi

  3. Department of Cardiology, Kita Medical Association Hospital, Kita, Japan

    Tadao Uraoka

Authors
  1. Shozo Sueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Oshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yousuke Izoe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroaki Kohno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroshi Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takaaki Ochi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tadao Uraoka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shozo Sueda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sueda, S., Oshita, A., Izoe, Y. et al. A long-acting calcium antagonist over one year did not improve BMIPP myocardial scintigraphic imagings in patients with pure coronary spastic angina. Ann Nucl Med 21, 85–92 (2007). https://doi.org/10.1007/BF03033985

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03033985

Key words

Search

Navigation