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Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries

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A Correction to this article was published on 03 November 2022

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Abstract

Background

Coronary vasomotor dysfunction represents an important mechanism responsible for myocardial ischaemia in patients with non-obstructive coronary artery disease (CAD). The use of invasive provocative tests allows identifying patients with epicardial or microvascular spasm. Of note, clinical characteristics associated with the occurrence of epicardial or microvascular spasm have still not completely clarified.

Methods and results

We prospectively enrolled consecutive patients undergoing coronary angiography for suspected myocardial ischaemia/necrosis with evidence of non-obstructive CAD and undergoing intracoronary provocative test for suspected vasomotor dysfunction. Patients with a positive provocative test were enrolled. Clinical, echocardiographic and angiographic characteristics of patients were evaluated according to the pattern of vasomotor dysfunction (epicardial vs. microvascular spasm). We included 120 patients [68 patients with stable angina and 52 patients with myocardial infarction and non-obstructive coronary arteries (MINOCA)]. In particular, 77 (64.2%) patients had a provocative test positive for epicardial spasm and 43 (35.8%) patients for microvascular spasm. Patients with epicardial spasm were more frequently males, smokers, had higher rates of diffuse coronary atherosclerosis at angiography and more frequently presented with MINOCA. On the other hand, patients with microvascular spasm presented more frequently diastolic dysfunction. At multivariate logistic regression analysis male sex, smoking, and diffuse coronary atherosclerosis were independent predictors for the occurrence of epicardial spasm.

Conclusions

Our study showed that specific clinical features are associated with different responses to intracoronary provocative test. Epicardial spasm is more frequent in males and in MINOCA patients, whereas microvascular spasm is more frequent in patients with stable angina and is associated with diastolic dysfunction.

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Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 1, 00168, Rome, Italy

    Rocco Antonio Montone, Giampaolo Niccoli, Domenico D’Amario, Antonino Buffon, Antonio M. Leone, Francesco Burzotta, Cristina Aurigemma, Carlo Trani, Giovanna Liuzzo, Gaetano A. Lanza & Filippo Crea

  2. Catholic University of the Sacred Heart, Rome, Italy

    Giampaolo Niccoli, Michele Russo, Marta Giaccari, Marco Giuseppe Del Buono, Maria Chiara Meucci, Filippo Gurgoglione, Rocco Vergallo, Antonino Buffon, Francesco Burzotta, Carlo Trani, Giovanna Liuzzo, Gaetano A. Lanza & Filippo Crea

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Correspondence to Giampaolo Niccoli.

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Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institutional committee (Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore; Code 26710/13) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Additional information

The original online version of this article was revised: the author's name Filippo Gurgoglione was incorrectly given as Filippo Gurguglione.

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Montone, R.A., Niccoli, G., Russo, M. et al. Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries. Clin Res Cardiol 109, 435–443 (2020). https://doi.org/10.1007/s00392-019-01523-w

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