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1.
Figure 4.

Figure 4. From: Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease.

Percentage of patients with microvascular coronary artery spasm (M-CAS), epicardial coronary artery spasm (E-CAS), and non–ischemic heart disease (non-IHD) in patients with suspected nonobstructive coronary artery disease (nonobstructive CAD). M-CAS was significantly more frequent in women than in men (45 women [21.3%] vs 5 men [3.1%], *P<0.0001).

Keisuke Ohba, et al. J Am Heart Assoc. 2012 October;1(5):e002485.
2.
Figure 2.

Figure 2. From: Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease.

Scheme of categorization. This scheme shows the categorization of the non–ischemic heart disease (non-IHD), epicardial coronary artery spasm (epicardial CAS), and microvascular coronary artery spasm (microvascular CAS) in the intracoronary acetylcholine-provocation test. Microvascular CAS was defined as myocardial ischemia with the occurrence of chest pain, ischemic electrocardiogram changes, transcardiac lactate production, and a decrease in quantitative coronary blood flow (CBF) without epicardial coronary vasospasm using the acetylcholine-provocation test. CAG indicates coronary angiography; ECG, electrocardiogram.

Keisuke Ohba, et al. J Am Heart Assoc. 2012 October;1(5):e002485.
3.
Figure 5.

Figure 5. From: Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease.

Changes in the quantitative coronary blood flow of the left anterior descending coronary artery in response to increasing doses of acetylcholine (ACh). The green bar shows non–ischemic heart disease (non-IHD), the yellow bar shows epicardial coronary artery spasm (E-CAS), and the red bar shows microvascular coronary artery spasm (M-CAS). The data shown are the mean±standard error of the mean of the percent change from each baseline.

Keisuke Ohba, et al. J Am Heart Assoc. 2012 October;1(5):e002485.
4.
Figure 3.

Figure 3. From: Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease.

One case of microvascular coronary artery spasm. A representative case of microvascular coronary artery spasm is presented. Epicardial vasospasm is not induced by acetylcholine (ACh); however, the velocity of the coronary flow declines, thus, the quantitative coronary blood flow decreases. The transcardiac lactate production ratio then becomes positive during coronary circulation. Patients with microvascular coronary artery spasm showed decreases in the average peak velocity from baseline. BMI indicates body mass index; CAG, coronary angiography; CBF, coronary blood flow; and HDL, high-density lipoprotein-cholesterol.

Keisuke Ohba, et al. J Am Heart Assoc. 2012 October;1(5):e002485.
5.
Figure 6.

Figure 6. From: Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease.

Changes in coronary artery parameters and the transcardiac lactate production ratio. A, Changes in the diameter of the left anterior descending coronary artery (LAD) in response to high-dose acetylcholine (ACh; 100 μg) in each segment. B, Transcardiac lactate production ratio in response to high-dose ACh. C, Changes in the diastolic-to-systolic velocity ratio in response to intracoronary administration of isosorbide dinitrate (ISDN). D, Changes in the diameter of the LAD in response to ISDN. The green bar shows non–ischemic heart disease (non-IHD), the yellow bar shows epicardial coronary artery spasm (E-CAS), and the red bar shows microvascular coronary artery spasm (M-CAS). The data shown are the mean ± standard error of the mean of the percent change from each baseline (A, C, and D).

Keisuke Ohba, et al. J Am Heart Assoc. 2012 October;1(5):e002485.
6.
Figure 1.

Figure 1. From: Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease.

Diagnostic flowchart. The grouping of the patients in this study is shown. Microvascular coronary artery spasm (microvascular CAS) is diagnosed by the intracoronary acetylcholine-provocation test on the basis of the following criteria: positive for lactate production and a decrease in quantitative coronary blood flow without epicardial vasospasm, associated with the occurrence of chest symptoms and ischemic changes in the electrocardiogram. The numbers in the 4 boxes at the bottom of the diagram denote the number of patients in each group. The vertical lines connecting the boxes indicate the diagnostic processes. ATP-CFR indicates adenosine triphosphate–induced coronary flow reserve; epicardial CAS, epicardial coronary artery spasm; IHD, ischemic heart disease; and SPECT, single-photon emission computed tomography.

Keisuke Ohba, et al. J Am Heart Assoc. 2012 October;1(5):e002485.
7.
Figure 7.

Figure 7. From: Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease.

Receiver-operating characteristics curve analysis in the presence of microvascular coronary artery spasm (microvascular CAS) in patients with suspected nonobstructive coronary artery disease (CAD). The receiver-operating characteristic curve analysis was performed to assess the ability of the 5-variable model (female sex, lower body mass index [BMI <25 kg/m2], minor–borderline ischemic electrocardiogram [ECG] findings at rest, a limited–baseline diastolic-to-systolic velocity ratio [DSVR <1.7], and an attenuated adenosine triphosphate–induced coronary flow reserve [ATP-CFR <2.5]) and a Framingham risk score (negatively converted values) alone to predict the presence of microvascular CAS among the patients with suspected nonobstructive CAD. The area under the curve for the prediction of microvascular CAS was 0.820 (95% confidence interval [CI], 0.756–0.884; P<0.0001) for the 5-variable model and 0.636 (95% CI, 0.554–0.719; P=0.003) for a negative Framingham risk score, which were significantly different from each other (P=0.0004).

Keisuke Ohba, et al. J Am Heart Assoc. 2012 October;1(5):e002485.

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