Affiliation:
1. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
2. Department of Community Medicine, Kumamoto University Hospital, Kumamoto, Japan
Abstract
Background
Myocardial lactate production in the coronary circulation during acetylcholine (
AC
h)‐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.
Methods and Results
We examined all 712 patients who underwent both myocardial lactate measurement during
AC
h‐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
AC
h‐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
AC
h‐provoked myocardial ischemia in patients with coronary spasm.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
11 articles.
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