Abstract
While fixed coronary stenoses have traditionally been regarded as the principal determinant of myocardial perfusion, it has become increasingly apparent that vasomotor tone superimposed on a preexisting fixed stenosis plays an important pathophysiologic role in angina pectoris both at rest and on exercise [1–3]. Spasm plays an integral role in variant angina in particular [4–8]. MacAlpin proposed that the coronary spasm of variant angina is due to the amplification of normal vasoconstriction at sites of atheromatous luminal encroachments, the degree of vasoconstriction being related to the severity of encroachments (the geometric theory) [9]. The present study was performed to determine the applicability of the geometric theory to the coronary spasm of patients with variant angina and to assess the variability of coronary spasm over time, using a computer-based coronary angiography analysis system (CAAS). We assessed vasocontractility in 18 patients with variant angina by measuring the maximal changes in coronary arterial diameter induced by repeated ergonovine provocation tests. Using elementary geometric principles, we calculated the vasospastic changes that might be expected to occur at sites of fixed coronary stenosis on the basis of proportional vasomotion in normal proximal reference segments.
Dr. David Keane is a receipient of a travel grant of the Peel Trust for Medical Research UK
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Ozaki, Y., Keane, D., Haase, J., Takatsu, F., Serruys, P.W. (1994). Long-term responsiveness to intracoronary ergonovine in variant angina. In: Serruys, P.W., Foley, D.P., De Feyter, P.J. (eds) Quantitative Coronary Angiography in Clinical Practice. Developments in Cardiovascular Medicine, vol 145. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-8358-9_18
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DOI: https://doi.org/10.1007/978-94-015-8358-9_18
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