{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:19:36Z","timestamp":1791883176138,"version":"4.3.4"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2012,9,26]]},"abstract":"\n \n Background<\/jats:italic>\n <\/jats:title>\n \n Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular\u00a0\n CAS<\/jats:styled-content>\n ) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular\u00a0\n CAS<\/jats:styled-content>\n and the therapeutic efficacy of calcium channel blockers.\n <\/jats:p>\n <\/jats:sec>\n \n \n Methods and Results<\/jats:italic>\n <\/jats:title>\n \n Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular\u00a0\n CAS<\/jats:styled-content>\n according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular\n CAS<\/jats:styled-content>\n who demonstrated significant impairment of the endothelium\u2010dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular\n CAS<\/jats:styled-content>\n . Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor\u2013borderline ischemic electrocardiogram findings at rest, limited\u2013baseline diastolic\u2010to\u2010systolic velocity ratio, and attenuated adenosine triphosphate\u2013induced coronary flow reserve were independently correlated with the presence of microvascular\n CAS<\/jats:styled-content>\n . Receiver\u2010operating characteristics curve analysis revealed that the aforementioned 5\u2010variable model showed good correlation with the presence of microvascular\n CAS<\/jats:styled-content>\n (area under the curve: 0.820). No patients with microvascular\n CAS<\/jats:styled-content>\n treated with calcium channel blockers developed cardiovascular events over 47.8\u00b127.5 months.\n <\/jats:p>\n <\/jats:sec>\n \n \n Conclusions<\/jats:italic>\n <\/jats:title>\n \n Microvascular\n CAS<\/jats:styled-content>\n causes distinctive clinical features and endothelial dysfunction that are important to recognize as nonobstructive coronary artery disease so that optimal care with calcium channel blockers can be provided.\n <\/jats:p>\n <\/jats:sec>\n \n \n Clinical Trial Registration<\/jats:italic>\n <\/jats:title>\n \n URL:\n www.umin.ac.jp\/ctr<\/jats:ext-link>\n . Unique identifier: UMIN000003839.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.112.002485","type":"journal-article","created":{"date-parts":[[2013,5,24]],"date-time":"2013-05-24T12:46:06Z","timestamp":1369399566000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":97,"title":["Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease"],"prefix":"10.1161","volume":"1","author":[{"given":"Keisuke","family":"Ohba","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seigo","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto 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