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The high prevalence of nonobstructive coronary artery disease (CAD) in those patients has recently been reported not only in Japan but also in Western countries, and is clinically attracting attention. Coronary spasm is considered to be one of the leading causes of both suspected stable angina and ACS with nonobstructive coronary arteries. Coronary spasm could also be associated with left ventricular dysfunction leading to heart failure, which could be improved following the administration of calcium channel blockers. Because we rarely capture spontaneous attacks of coronary spasm with electrocardiograms or Holter recordings, an invasive diagnostic modality, acetylcholine (ACh) provocation test, can be useful in detecting coronary spasm during CAG. Furthermore, we can use the ACh-provocation test to identify high-risk patients with coronary spasm complicated with organic coronary stenosis, and then treat with intensive care. Nonobstructive CAD includes not only epicardial coronary spasm but also microvascular spasm or dysfunction that can be associated with recurrent anginal attacks and poor quality of life. ACh-provocation test could also be helpful for the assessment of microvascular spasm or dysfunction. We hope that cardiologists will increasingly perform ACh-provocation test to assess the pathophysiology of nonobstructive CAD.<\/jats:p>","DOI":"10.1007\/s12928-020-00720-z","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T02:03:07Z","timestamp":1603764187000},"page":"39-51","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease"],"prefix":"10.1007","volume":"36","author":[{"given":"Satoru","family":"Suzuki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Kaikita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichiro","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Jinnouchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Tsujita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"key":"720_CR1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1038\/s41569-019-0273-3","volume":"17","author":"TM Waterbury","year":"2020","unstructured":"Waterbury TM, Tarantini G, Vogel B, Mehran R, Gersh BJ, Gulati R. 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Dr. Tsujita has received honoraria from Amgen Astellas BioPharma K.K., Kowa Pharmaceutical Co. Ltd., Daiichi Sankyo Co., Ltd., Takeda Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., Pfizer Japan Inc., Bristol-Myers K.K., and MSD K.K.; trust research\/joint research funds from Bristol-Myers K.K., Sugi Bee Garden Co., LTD., and Kowa Pharmaceutical Co. Ltd.; and grants from ITI Co., Ltd., Abbott Medical Japan L.L.C., Abbott Vascular Japan Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Cardinal Health Japan., Kaneka Medix Co., Ltd., Takeda Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma, Chugai Pharmaceutical Co., Ltd., TERUMO Co., Ltd., NIPRO CORPORATION., NIHON KOHDEN CORPORATION., Medtronic Japan Co., Ltd., Japan Lifeline Co., Ltd., Fides-One, Inc., Fukuda Denshi Co., Ltd., and Boston Scientific Japan K.K.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}