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1. Heart Vessels. 2024 Oct 5. doi: 10.1007/s00380-024-02469-4. Online ahead of print. Association between serum level of uric acid in Japanese young patients with coronary spastic angina receiving coronary angiography. Tanazawa K(1), Akioka H(2), Yufu K(1), Makita T(1), Sato H(1), Iwabuchi Y(1), Ono Y(1), Yamasaki H(1), Takahashi M(1), Ogawa N(1), Harada T(1), Mitarai K(1), Kodama N(1), Yamauchi S(1), Takano M(1), Hirota K(1), Miyoshi M(1), Yonezu K(1), Tawara K(1), Abe I(1), Kondo H(1), Saito S(1), Fukui A(1), Fukuda T(1), Shinohara T(1), Akiyoshi K(1), Teshima Y(1), Takahashi N(1). Author information: (1)Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan. (2)Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan. akioka0920@oita-u.ac.jp. Endothelial dysfunction may trigger coronary spastic angina (CSA). However, the risk factors for CSA in young patients remain unclear. This study aimed to investigate the age-dependent role of serum uric acid levels in patients with CSA. We enrolled 423 patients who underwent an ergonovine tolerance test during coronary angiography for the CSA evaluation. We categorized the patients as (1) young (age ≤ 65 years) CSA-positive (n = 33), (2) young CSA-negative (n = 138), (3) elderly (age > 66 years) CSA-positive (n = 42), and (4) elderly CSA-negative (n = 210) groups. In the young groups, the smoker proportion (57.6 vs. 38.4%, p = 0.04) and serum uric acid levels (6.3 ± 1.4 vs. 5.4 ± 1.5 mg/dl, p = 0.006) were significantly higher in the CSA-positive compared with the CSA-negative group. Conversely, in the elderly group, the male proportion (66.6 vs. 47.1%, p = 0.02) and alcohol consumption level (40.5 vs. 21.0%, p = 0.01) were significantly higher in the CSA-positive compared with the CSA-negative group. The multivariate analysis in young groups revealed the independent association between the serum uric acid level (p = 0.02) and the presence of CSA. Our results indicate that elevated serum uric acid levels may affect CSA development in young patients. © 2024. Springer Nature Japan KK, part of Springer Nature. DOI: 10.1007/s00380-024-02469-4 PMID: 39368018 2. Eur Cardiol. 2024 Aug 21;19:e16. doi: 10.15420/ecr.2022.12. eCollection 2024. A Review of the Role of Tests of Coronary Reactivity in Clinical Practice. Sueda S(1), Sakaue T(2). Author information: (1)Department of Cardiology, Ehime Niihama Prefectural Hospital Niihama, Japan. (2)Department of Cardiology, Yawatahama City General Hospital Yawatahama, Japan. Vasoreactivity testing is used by cardiologists in the diagnosis of coronary spasm endotypes, such as epicardial and microvascular spasm. Intracoronary injection of acetylcholine and ergonovine is defined as a standard class I method according to the Coronary Vasomotion Disorder (COVADIS) Group. Because single vasoreactivity testing may have some clinical limitations in detecting the presence of coronary spasm, supplementary or sequential vasoreactivity testing should be reconsidered. The majority of cardiologists do not consider pseudonegative results when performing these vasoreactivity tests. Vasoreactivity testing may have some limitations when it comes to documenting clinical spasm. In the future, cardiologists around the world should use multiple vasoreactivity tests to verify the presence or absence of epicardial and microvascular spasms in the cardiac catheterisation laboratory. Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd. DOI: 10.15420/ecr.2022.12 PMCID: PMC11363052 PMID: 39220616 Conflict of interest statement: Disclosure: The authors have no conflicts of interest to declare. 3. Clin Cardiol. 2024 Sep;47(9):e70004. doi: 10.1002/clc.70004. Lack of Class I Vasoreactivity Testing for Diagnosing Patients With Coronary Artery Spasm. Sueda S(1), Hayashi Y(1), Ono H(2), Okabe H(2), Sakaue T(3), Ikeda S(3). Author information: (1)Department of Cardiology, Minami Matsuyama Hospital, Matsuyma City, Ehime, Japan. (2)Department of Cardiology, Ehime Prefectural Niihama Hospital, Niihama, Ehime, Japan. (3)Department of Cardiology, Ehime University Graduate School of Medicine, Touon-shi, Ehime, Japan. BACKGROUND: Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS). HYPOTHESIS: Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm. METHODS: Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I. RESULTS: There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent. CONCLUSIONS: Cardiologists should understand the imperfection of these vasoreactivity tests when diagnosing patients with VSA. © 2024 The Author(s). Clinical Cardiology published by Wiley Periodicals, LLC. DOI: 10.1002/clc.70004 PMCID: PMC11350217 PMID: 39192815 [Indexed for MEDLINE] Conflict of interest statement: The authors declare no conflicts of interest. 4. J Cardiovasc Dev Dis. 2024 Jul 10;11(7):217. doi: 10.3390/jcdd11070217. Factors Contributing to Coronary Microvascular Dysfunction in Patients with Angina and Non-Obstructive Coronary Artery Disease. Teragawa H(1), Uchimura Y(1), Oshita C(1), Hashimoto Y(1), Nomura S(1). Author information: (1)Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36, Futabanosato, Higashi-Ku, Hiroshima 732-0057, Japan. BACKGROUND: Coronary microvascular dysfunction (CMD), characterised by a reduced coronary flow reserve (CFR) or an increased index of microcirculatory resistance (IMR), has received considerable attention as a cause of chest pain in recent years. However, the risks and causes of CMD remain unclear; therefore, effective treatment strategies have not yet been established. Heart failure or coronary artery disease (CAD) is a risk factor for CMD, with a higher prevalence among women. However, the other contributing factors remain unclear. In this study, we assessed the risk in patients with angina and non-obstructive coronary artery disease (ANOCA), excluding those with heart failure or organic stenosis of the coronary arteries. Furthermore, we analysed whether the risk of CMD differed according to component factors and sex. METHODS: This study included 84 patients with ANOCA (36 men and 48 women; mean age, 63 years) who underwent coronary angiography and functional testing (CFT). The CFT included a spasm provocation test (SPT), followed by a coronary microvascular function test (CMVF). In the SPT, patients were mainly provoked by acetylcholine (ACh), and coronary spasm was defined as >90% transient coronary artery constriction on coronary angiography, accompanied by chest pain or ischaemic changes on electrocardiography. In 15 patients (18%) with negative ACh provocation, ergonovine maleate (EM) was administered as an additional provocative drug. In the CMVF, a pressure wire was inserted into the left anterior descending coronary artery using intravenous adenosine triphosphate, and the CFR and IMR were measured using previously described methods. A CFR < 2.0 or IMR ≥ 25 was indicative of CMD. The correlations between various laboratory indices and CMD and its components were investigated, and logistic regression analysis was performed, focusing on factors where p < 0.05. RESULTS: Of the 84 patients, a CFR < 2.0 was found in 22 (26%) and an IMR ≥ 25 in 40 (48%) patients, with CMD identified in 46 (55%) patients. CMD was correlated with smoking (p = 0.020) and the use of EM (p = 0.020). The factors that correlated with a CFR < 2.0 included the echocardiograph index E/e' (p = 0.013), which showed a weak but positive correlation with the CFR (r = 0.268, p = 0.013). Conversely, the factors correlated with an IMR ≥ 25 included RAS inhibitor usage (p = 0.018) and smoking (p = 0.042). Assessment of the risk of CMD according to sex revealed that smoking (p = 0.036) was the only factor associated with CMD in men, whereas the left ventricular mass index (p = 0.010) and low glycated haemoglobin levels (p = 0.012) were associated with CMD in women. CONCLUSIONS: Our results indicated that smoking status and EM use were associated with CMD. The risk of CMD differed between the two CMD components and sex. Although these factors should be considered when treating CMD, smoking cessation remains important. In addition, CMD assessment should be performed carefully when EM is used after ACh provocation. Further validation of our findings using prospective studies and large registries is warranted. DOI: 10.3390/jcdd11070217 PMCID: PMC11277519 PMID: 39057637 Conflict of interest statement: The authors have no potential conflicts of interest to declare. 5. Cureus. 2024 Jun 4;16(6):e61640. doi: 10.7759/cureus.61640. eCollection 2024 Jun. QT Prolongation and Torsade De Pointes After Catheter Ablation for Persistent Atrial Fibrillation in a Patient With Tachycardia-Induced Cardiomyopathy: A Case Report. Yamashita D(1), Fujimoto N(1), Kagawa Y(1), Fujita S(1), Dohi K(1). Author information: (1)Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, JPN. Atrial fibrillation (AF) is the most common cause of tachycardia-induced cardiomyopathy (TIC). A 75-year-old woman was referred to our hospital for catheter ablation for persistent AF. On admission, transthoracic echocardiography (TTE) revealed diffuse left ventricular (LV) hypokinesis, which was suspected to be due to TIC. Catheter ablation was performed on the fifth day of hospitalization, and Torsade de Pointes (TdP) appeared on the sixth day. The serum concentration of bepridil and potassium was below the reference level. An electrocardiogram revealed marked QT prolongation, giant-negative T waves, and T-wave alternans on the seventh day of hospitalization. Cardiac magnetic resonance imaging with no contrast indicated diffuse mild LV hypokinesis, mild prolonged native T1, and no evidence of myocardial edema at T2. Coronary angiography revealed normal coronary arteries, and the ergonovine stress test results were negative. The results for five long QT syndrome susceptibility genes, including the three major genes, were negative. Subsequently, QT prolongation, giant-negative T waves, and LV dysfunction improved without treatment. This case report highlights the importance of risk management for AF patients with TIC scheduled for catheter ablation and carefully evaluating the risks of QT prolongation. Moreover, patients with TIC can experience marked QT prolongation and TdP during the perioperative period of catheter ablation. Therefore, caution should be required. Copyright © 2024, Yamashita et al. DOI: 10.7759/cureus.61640 PMCID: PMC11223721 PMID: 38966463 Conflict of interest statement: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.