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Assessment of coronary spasms with transluminal attenuation gradient in coronary computed tomography angiographyopen access

Authors
Park, Jae YangKang, Eun-JuKim, Moo HyunYong, Hwan SeokRha, Seung-Woon
Issue Date
8-7월-2022
Publisher
PUBLIC LIBRARY SCIENCE
Citation
PLOS ONE, v.17, no.7
Indexed
SCIE
SCOPUS
Journal Title
PLOS ONE
Volume
17
Number
7
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/146623
DOI
10.1371/journal.pone.0271189
ISSN
1932-6203
Abstract
Purpose To evaluate the imaging features of coronary spasm, including transluminal attenuation gradient (TAG) on coronary computed tomography angiography (CCTA), in patients with vasospastic angina (VA). Methods A total of 43 patients with a high clinical likelihood of VA were included in the study. All the subjects underwent double CCTA acquisition: CCTA without a vasodilator (`baseline CT') and CCTA during continuous intravenous nitrate infusion (`IV nitrate CT'). A catheterized ergonovine provocation test was used to determine true VA patients. Coronary spasm is classified into focal- and diffuse-types according to morphological differences. We measured TAG and contrast enhancement of the proximal ostium (ProxHU) of each coronary artery for both the baseline and IV nitrate CT. Results Twenty-four patients (55.8%) showed positive results of coronary vasospasm on the provocation test. Thirty-eight vessels showed coronary spasms (29.5%): Focal-type in nine vessels (24%), and diffuse-type in 29 (76%). In the baseline CT, LCX showed significantly lower (steeper) TAG in spasm(+) vessels than in spasm(-) vessels, while LAD and RCA showed no significant differences in TAG. The ProxHU of LAD showed significantly lower values in spasm(+) vessels than in spasm(-) vessels, while the other vessels did not show significant differences in ProxHU. For IV nitrate CT, there were no significant differences in either the TAG and ProxHU between spasm(+) and (-) vessels for all the three vessel types. In subgroup analysis for spasm(+) vessels, diffuse spasms showed significantly lower TAG than focal spasms, while the ProxHU did not differ between the two types of spasm. Conclusions A relatively large percentage of coronary spasms present as diffuse type, and the TAG values significantly differed according to the morphological type of the coronary spasm.
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