{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T02:16:02Z","timestamp":1790388962485,"version":"4.1.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,1,19]]},"abstract":"\n Background<\/jats:title>\n The underlying pathophysiology of coronary artery spasm (CAS) remains unclear. We aim to determine whether coronary artery medial layer thickness is associated with CAS using optical coherence tomography.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n A total of 50 patients with previous myocardial infarction underwent optical coherence tomography of the left anterior descending artery: 20 with CAS and 30 without CAS. Intimal and medial layer areas were measured by planimetric analysis of optical coherence tomography images. The medial area\/external elastic membrane (EEM) area was significantly greater in patients with than without CAS (0.13\u00b10.01 versus 0.09\u00b10.01, respectively,\n P<\/jats:italic>\n <0.01), whereas the intimal area\/EEM area was similar in the 2 groups. In patients without CAS, the relationship of intimal area\/EEM area with medial area\/EEM area and coronary diameter response to intracoronary injection of acetylcholine was characterized by an inverted U\u2010shaped curve (\n y<\/jats:italic>\n =\u22121.85\n x<\/jats:italic>\n 2<\/jats:sup>\n +0.81\n x<\/jats:italic>\n +0.01,\n R<\/jats:italic>\n 2<\/jats:sup>\n =0.43,\n P<\/jats:italic>\n <0.001) and a U\u2010shaped curve (\n y<\/jats:italic>\n =2993.2\n x<\/jats:italic>\n 2<\/jats:sup>\n \u22121359.6\n x<\/jats:italic>\n +117.1,\n R<\/jats:italic>\n 2<\/jats:sup>\n =0.53,\n P<\/jats:italic>\n <0.001), respectively. Thus, the medial layer became thin and the contractile response became weak in coronary arteries with greater intimal area in the non\u2010CAS patients. In contrast, in patients with CAS, the intimal area\/EEM area had no significant relationship with the medial area\/EEM area in either linear correlation analysis or quadratic regression analysis. Thus, even when the intimal layer thickened, the medial layer did not thin in patients with CAS.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The structural thickness of the coronary medial layer was increased in patients with CAS, which may provide mechanistic insight into the pathogenesis of CAS.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n URL:\n https:\/\/www.upload.umin.ac.jp<\/jats:ext-link>\n ; Unique identifier: UMIN000018432.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.120.018028","type":"journal-article","created":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T10:21:52Z","timestamp":1610619712000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Structural Thickening of Medial Layer in Coronary Artery With Spasm in Patients With Myocardial Infarction"],"prefix":"10.1161","volume":"10","author":[{"given":"Takamitsu","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II University of Yamanashi Chuo Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeo","family":"Horikoshi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II University of Yamanashi Chuo Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9138-4825","authenticated-orcid":false,"given":"Kiyotaka","family":"Kugiyama","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II University of Yamanashi Chuo Yamanashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.36.760"},{"issue":"1","key":"e_1_3_1_3_2","first-page":"115","article-title":"Assessment of endothelial modulation of coronary vasomotor tone: insights into a fundamental functional disturbance in vascular biology of atherosclerosis","volume":"89","author":"Zeiher AM","year":"1994","unstructured":"Zeiher AM, Sch\u00e4chinger V, Saurbier B, Just H. Assessment of endothelial modulation of coronary vasomotor tone: insights into a fundamental functional disturbance in vascular biology of atherosclerosis. Basic Res Cardiol. 1994;89(suppl 1):115\u2013128.","journal-title":"Basic Res Cardiol"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.78.1.1"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00537.2019"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9150(93)90039-W"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960120103"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.06.046"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.94.3.266"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI1699"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.108.175976"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vph.2012.01.006"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00520-8"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(99)00172-2"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.108.821371"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.01.051"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.120.018028","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:11:46Z","timestamp":1715598706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.120.018028"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,19]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,1,19]]}},"alternative-id":["10.1161\/JAHA.120.018028"],"URL":"https:\/\/doi.org\/10.1161\/jaha.120.018028","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,19]]},"assertion":[{"value":"2020-06-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e018028"}}