Mechanisms underlying coronary spas

冠脉痉挛的潜在机制仍知之甚少。这项研究的目的是评估以下假设，即冠状动脉痉挛发展中的波动可能反映了邻近食道系统的输入。我们招募了因夜间性心绞痛发作而入院的患者。7例变异型心绞痛患者和5例冠状动脉疾病（CAD）患者同时进行了ECG和食管测压监测。ECG监测记录了变异型心绞痛患者的28例ST升高和CAD患者的16例ST抑郁。测压分析表明，变异型心绞痛患者（143例总痉挛；个体范围9-31）比CAD患者（20例总痉挛；个体范围0-9； P <0.01）明显多发生食管痉挛。时间序列分析用于评估食管异常波的发生及其与自发性ST移位的关系。CAD中食管痉挛发作偶发（在ECG记录的缺血前1至5分钟）（P <0.05）。双向因果关系分析表明，在变异型心绞痛中，食管和冠状动脉痉挛之间的影响过程是相互的和相互的（传递函数模型，P <0.05）。我们得出结论，在变异型心绞痛患者中，食管痉挛发作和心肌缺血相互影响。引起食道痉挛的机制可以反馈产生冠状动脉痉挛。冠状动脉痉挛可能会导致其他食管痉挛发作。

冠状动脉痉挛背后的机制仍然不为人所知。这项研究的目的是评估冠心病发育波动可能反映相邻食管系统输入的假设。我们登记了夜间心绞痛发作的冠心病护理室患者。7名变异性心绞痛患者和5名冠状动脉疾病（CAD）患者同时进行心电图和食管计量监测。ECG监测记录了28例变异性心绞痛患者的ST高程和16例ST抑郁症在CAD患者。计量分析表明，食管痉挛在变异性性绞痛患者（143例总痉挛;个体范围9-31）中比CAD患者（20次总痉挛;个体范围0-9）中发生频率显著提高;P < 0.01）。时间序列分析用于评估食管异常波的发生波动及其与ST移位自发发作的关系。CAD食管痉挛发作是零星的（在心电图记录缺血前1至5分钟）（P

Mechanisms underlying coronary spasm are still poorly understood. The aim of the study was to assess the hypothesis that fluctuations in the development of coronary spasm might reflect inputs from the adjacent esophageal system. We enrolled patients admitted to the coronary care unit for episodes of nocturnal angina. Seven patients with variant angina and five with coronary artery disease (CAD) had concurrent ECG and esophageal manometric monitoring. ECG monitoring documented 28 episodes of ST elevation in variant angina patients and 16 episodes of ST depression in CAD patients. Manometric analysis showed that esophageal spasms resulted remarkably more frequently in variant angina patients (143 total spasms; individual range 9-31) than in CAD patients (20 total spasms; individual range 0-9; P < 0.01). Time series analysis was used to assess fluctuations in the occurrence of abnormal esophageal waves and its relationship with spontaneous episodes of ST shift. Episodes of esophageal spasm in CAD were sporadic (1 into 5 min before ECG-recorded ischemia) (P < 0.05). A bidirectional analysis of causal effects showed that the influence processes between esophageal and coronary spasms were mutual and reciprocal (transfer function model, P < 0.05) in variant angina. We concluded that in variant angina patients, episodes of esophageal spasms and myocardial ischemia influenced each other. Mechanisms that cause esophageal spasm can feed back to produce coronary spasm. Coronary spasm may feed forward to produce additional episodes of esophageal spasm.<BR>