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Assessment of coronary vasomotor responses to acetylcholine in German and Japanese patients with epicardial coronary spasm—more similarities than differences?

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Abstract

Coronary spasm is an established cause for angina pectoris. Ethnic differences have been suggested among Asian compared to Caucasian patients regarding prevalence, gender distribution, and angiographic patterns of coronary spasm. The aim of this study was to compare contemporary German and Japanese patients with coronary spasm. Between 2011 and 2015, 149 patients with resting angina and unobstructed coronary arteries with acetylcholine-induced epicardial spasm were enrolled in Stuttgart, Germany (n = 69) and Sendai, Japan (n = 80). All patients underwent intracoronary acetylcholine testing according to a standardized protocol. Comprehensive analysis included type of spasm (focal/diffuse), dose of acetylcholine leading to spasm, and frequency of multivessel spasm. Patients in this study were 61 ± 11 years old, predominantly female (54%), and had normal left ventricular ejection fraction (73 ± 9%). Diffuse spasm was the most prevalent type of spasm (85%) whereas focal spasm was found in the remaining 15% of patients. 31% of patients had multivessel spasm. Comparing the German with the Japanese patients, distribution of spasm type (focal/diffuse, p = 0.19) and frequency of multivessel spasm (p = 0.22) were comparable. Moreover, when Japanese patients were compared with German patients and diffuse spasm with focal spasm patients, respectively, no significant differences were observed regarding the acetylcholine dose required to induce spasm (p = 0.078 and p = 0.46, respectively). In conclusion, diffuse epicardial coronary spasm is the most frequent finding among German and Japanese patients with resting angina, unobstructed coronary arteries, and epicardial spasm on acetylcholine testing. Japanese and German patients share several similarities including comparable types of spasm and frequency of multivessel spasm.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

ACh:

Acetylcholine

ECG:

Electrocardiogram

JCS:

Japanese Circulation Society

LCA:

Left coronary artery

MINOCA:

Myocardial infarction with non-obstructed coronary arteries

RCA:

Right coronary artery

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Acknowledgements

The authors are grateful to nurses and technicians in the catheterization laboratories and to all the staff members of the Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany and the Department of Cardiovascular Medicine, Tohoku University Hospital of Sendai, Japan, for their help and support during the study.

Funding

This work was funded in part by the Robert Bosch Foundation, Stuttgart, Germany and the Berthold Leibinger Foundation, Ditzingen Germany.

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Author notes

  1. Akira Suda, Andreas Seitz, Hiroaki Shimokawa and Peter Ong contributed equally to this study.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Tohoku University Hospital, Tohoku University Graduate School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai, 980-8574, Japan

    Akira Suda, Yuji Odaka, Koichi Sato, Kiyotaka Hao, Jun Takahashi & Hiroaki Shimokawa

  2. Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany

    Andreas Seitz, Anastasios Athanasiadis, Giancarlo Pirozzolo, Raffi Bekeredjian, Udo Sechtem & Peter Ong

Authors
  1. Akira Suda
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  2. Andreas Seitz
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Contributions

All authors meet ICMJE recommendation criteria for authorship in this manuscript. AS, AS, HS, PO: study design, data analysis, manuscript preparation, final approval. YO, GP, KS, KH: data interpretation and manuscript preparation. AA, RB, JT, US: critical revision of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Hiroaki Shimokawa or Peter Ong.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted in accordance with the Helsinki Declaration. In both institutions (Sendai and Stuttgart) the ethical committees approved acetylcholine testing and scientific data acquisition.

Consent to participate

For the present retrospective data analysis, all data were handled anonymously.

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Suda, A., Seitz, A., Odaka, Y. et al. Assessment of coronary vasomotor responses to acetylcholine in German and Japanese patients with epicardial coronary spasm—more similarities than differences?. Heart Vessels 36, 337–344 (2021). https://doi.org/10.1007/s00380-020-01707-9

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  • DOI: https://doi.org/10.1007/s00380-020-01707-9

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