Coronary vasospasm is a coronary artery vasomotor disorder in which transient hypercontraction of epicardial coronary arteries and/or the coronary microcirculation reduces myocardial blood flow. It overlaps clinically with vasospastic angina, Prinzmetal angina, and variant angina, and can present with rest angina, transient ischemic ECG changes, myocardial infarction, syncope, ventricular arrhythmia, or sudden cardiac arrest.
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name: Coronary Vasospasm
creation_date: "2026-05-06T03:09:02Z"
updated_date: "2026-05-06T03:09:02Z"
description: >-
Coronary vasospasm is a coronary artery vasomotor disorder in which transient
hypercontraction of epicardial coronary arteries and/or the coronary
microcirculation reduces myocardial blood flow. It overlaps clinically with
vasospastic angina, Prinzmetal angina, and variant angina, and can present
with rest angina, transient ischemic ECG changes, myocardial infarction,
syncope, ventricular arrhythmia, or sudden cardiac arrest.
category: Complex
disease_term:
preferred_term: coronary vasospasm
term:
id: MONDO:0005356
label: coronary vasospasm
parents:
- Coronary artery disorder
synonyms:
- Coronary artery vasospasm
- Coronary artery spasm
- Vasospastic angina
- Prinzmetal angina
- Variant angina
has_subtypes:
- name: Epicardial coronary vasospasm
display_name: Epicardial coronary vasospasm
classification: vasomotor_endotype
description: >-
Epicardial coronary vasospasm involves reversible constriction of an
epicardial coronary artery that can be visualized angiographically during
provocation testing.
evidence:
- reference: PMID:39493950
reference_title: Invasive Evaluation for Coronary Vasospasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Epicardial spasms can be visualized through coronary angiography as a
reversible epicardial vessel narrowing, while the diagnosis of
microvascular spasm can be made when angina symptoms and ECG changes happen
following intracoronary Ach without epicardial spasm.
explanation: >-
This supports epicardial coronary vasospasm as an angiographically visible
endotype of coronary vasospasm.
- name: Microvascular coronary vasospasm
display_name: Microvascular coronary vasospasm
classification: vasomotor_endotype
description: >-
Microvascular coronary vasospasm is supported when provocation testing
reproduces angina symptoms and ischemic ECG changes without angiographic
epicardial spasm.
evidence:
- reference: PMID:39493950
reference_title: Invasive Evaluation for Coronary Vasospasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Epicardial spasms can be visualized through coronary angiography as a
reversible epicardial vessel narrowing, while the diagnosis of
microvascular spasm can be made when angina symptoms and ECG changes happen
following intracoronary Ach without epicardial spasm.
explanation: >-
This supports microvascular coronary vasospasm as a diagnostically
distinct endotype of coronary vasospasm.
prevalence:
- population: ANOCA patients undergoing spasm provocation testing
percentage: '43'
notes: >-
Epicardial spasm prevalence in a meta-analysis of angina with
non-obstructive coronary arteries cohorts; this is not a general-population
prevalence estimate.
evidence:
- reference: PMID:36993994
reference_title: "Meta-analysis and systematic review of coronary vasospasm in ANOCA patients: Prevalence, clinical features and prognosis."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Epicardial spasm was prevalent in 43% (range 16-73%), with a higher
prevalence in Asian vs. Western World population (52% vs. 33%, p = 0.014).
explanation: >-
This systematic review provides a cohort-specific estimate for epicardial
coronary spasm among ANOCA patients evaluated with provocation testing.
pathophysiology:
- name: Coronary adventitial inflammation
description: >-
Coronary adventitial inflammation contributes to Rho-kinase upregulation in
vascular smooth muscle cells, priming coronary segments for abnormal
hypercontractile responses.
biological_processes:
- preferred_term: inflammatory response
modifier: INCREASED
term:
id: GO:0006954
label: inflammatory response
locations:
- preferred_term: coronary artery
term:
id: UBERON:0001621
label: coronary artery
downstream:
- target: Coronary vascular smooth muscle hyperreactivity
description: >-
Adventitial inflammation promotes Rho-kinase upregulation in coronary
vascular smooth muscle cells, increasing hypercontractility.
evidence:
- reference: PMID:37456775
reference_title: Mechanisms of Coronary Artery Spasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This review summarises the landmark studies on the mechanisms of coronary
vasospasm demonstrating the central role of Rho-kinase as a molecular
switch of VSMC hypercontraction and the important role of coronary
adventitial inflammation for Rho-kinase upregulation in VSMCs.
explanation: >-
This supports adventitial inflammation as an upstream contributor to
Rho-kinase-mediated smooth muscle hypercontraction.
- name: Coronary vascular smooth muscle hyperreactivity
description: >-
Coronary vascular smooth muscle cells undergo transient hypercontraction in
epicardial and/or microvascular coronary segments. Rho-kinase signaling acts
as a central molecular switch for VSMC hypercontraction.
cell_types:
- preferred_term: vascular associated smooth muscle cell
term:
id: CL:0000359
label: vascular associated smooth muscle cell
biological_processes:
- preferred_term: artery smooth muscle contraction
modifier: INCREASED
term:
id: GO:0014824
label: artery smooth muscle contraction
- preferred_term: Rho protein signal transduction
modifier: INCREASED
term:
id: GO:0007266
label: Rho protein signal transduction
- preferred_term: vasoconstriction
modifier: INCREASED
term:
id: GO:0042310
label: vasoconstriction
locations:
- preferred_term: coronary artery
term:
id: UBERON:0001621
label: coronary artery
downstream:
- target: Endothelial nitric oxide bioavailability defect
description: >-
VSMC hypercontraction is reinforced by impaired endothelial vasodilator
signaling and abnormal eNOS activity.
- target: Transient myocardial ischemia and electrical instability
description: >-
Episodic coronary narrowing lowers coronary blood flow and can trigger
ischemic pain, ECG changes, and rhythm instability.
evidence:
- reference: PMID:38541619
reference_title: "Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Coronary vasomotor disorders (CVD) are characterized by transient
hypercontraction of coronary vascular smooth muscle cells, leading to
hypercontraction of epicardial and/or microvascular coronary circulation.
explanation: >-
This review directly supports transient coronary vascular smooth muscle
hypercontraction as the core vasomotor abnormality.
- reference: PMID:37456775
reference_title: Mechanisms of Coronary Artery Spasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This review summarises the landmark studies on the mechanisms of coronary
vasospasm demonstrating the central role of Rho-kinase as a molecular
switch of VSMC hypercontraction and the important role of coronary
adventitial inflammation for Rho-kinase upregulation in VSMCs.
explanation: >-
This supports the Rho-kinase/VSMC hypercontraction mechanism and the role
of inflammation in amplifying it.
- name: Endothelial nitric oxide bioavailability defect
description: >-
Defective endothelial function reduces nitric oxide bioavailability and
weakens vasodilator signaling, allowing acetylcholine or other stimuli to
produce paradoxical constriction rather than normal coronary dilation.
cell_types:
- preferred_term: endothelial cell
term:
id: CL:0000115
label: endothelial cell
biological_processes:
- preferred_term: nitric oxide biosynthetic process
modifier: DECREASED
term:
id: GO:0006809
label: nitric oxide biosynthetic process
- preferred_term: response to oxidative stress
modifier: INCREASED
term:
id: GO:0006979
label: response to oxidative stress
- preferred_term: inflammatory response
modifier: INCREASED
term:
id: GO:0006954
label: inflammatory response
downstream:
- target: Coronary vascular smooth muscle hyperreactivity
description: Reduced nitric oxide bioavailability permits excessive coronary smooth muscle constriction.
evidence:
- reference: PMID:20049135
reference_title: Recent insights into the mechanisms of vasospastic angina.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Patients with vasospastic angina are known to have defective endothelial
function due to reduced nitric oxide bioavailability.
explanation: >-
This directly supports defective endothelial nitric oxide signaling in
vasospastic angina/coronary vasospasm.
- reference: PMID:20049135
reference_title: Recent insights into the mechanisms of vasospastic angina.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Thus, endothelial dysfunction through abnormalities of eNOS and enhanced
contractility of vascular smooth muscle in coronary artery segments are
considered major mechanisms in vasospastic angina.
explanation: >-
This links endothelial dysfunction and enhanced VSMC contractility as
major interacting mechanisms.
- name: Transient myocardial ischemia and electrical instability
description: >-
Coronary spasm acutely decreases coronary perfusion and produces myocardial
ischemia. Severe or prolonged ischemic episodes can provoke syncope,
ventricular tachyarrhythmias, myocardial infarction, or sudden cardiac
arrest.
biological_processes:
- preferred_term: response to hypoxia
modifier: ABNORMAL
term:
id: GO:0001666
label: response to hypoxia
locations:
- preferred_term: heart
term:
id: UBERON:0000948
label: heart
evidence:
- reference: PMID:38343041
reference_title: "Vasospastic angina: a review on diagnostic approach and management."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Coronary artery spasm is a heterogeneous phenomenon that can occur in
patients with non-obstructive coronary arteries and obstructive coronary
artery disease, with transient spasm causing chest pain and persistent
spasm potentially leading to acute myocardial infarction (MI).
explanation: >-
This supports transient spasm causing chest pain and persistent spasm
causing infarction.
- reference: PMID:29255500
reference_title: Life-threatening arrhythmias leading to syncope in patients with vasospastic angina.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Life-threatening arrhythmias are among the most serious complications of an
ischemic attack caused by coronary spasm, and are associated with an
increased risk of syncope and/or sudden cardiac death (SCD).
explanation: >-
This supports the downstream electrical instability and severe clinical
consequences caused by ischemic coronary spasm.
phenotypes:
- category: Cardiovascular
name: Coronary artery vasospasm
diagnostic: true
description: Spontaneous or provoked coronary artery spasm is the defining vasomotor abnormality.
phenotype_term:
preferred_term: Vasospasm
term:
id: HP:0025637
label: Vasospasm
evidence:
- reference: PMID:39493950
reference_title: Invasive Evaluation for Coronary Vasospasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
VSA presents with spontaneous coronary artery spasm (CAS); it has been
associated with stable angina, acute coronary syndromes, and sudden cardiac
death.
explanation: >-
This supports coronary artery spasm as the defining abnormality and links it
to major clinical presentations.
- category: Cardiovascular
name: Angina at rest
diagnostic: true
description: >-
Episodic chest pain commonly occurs at rest, particularly overnight or in the
early morning, as transient coronary spasm causes ischemia.
phenotype_term:
preferred_term: Angina at rest
term:
id: HP:0001681
label: Angina pectoris
evidence:
- reference: PMID:21389642
reference_title: "Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Ischemic episodes of variant angina show circadian variation and often
occur at rest from midnight to early morning.
explanation: >-
This supports rest angina with a nocturnal or early morning pattern as a
characteristic presentation.
- category: Cardiovascular
name: Transient ST-segment elevation
diagnostic: true
description: >-
Transient ST-segment elevation during an angina attack reflects acute
ischemia from coronary spasm.
phenotype_term:
preferred_term: Transient ST-segment elevation
term:
id: HP:0012251
label: ST segment elevation
evidence:
- reference: PMID:21389642
reference_title: "Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Variant angina is a form of angina pectoris that shows transient
ST-segment elevation on electrocardiogram during an attack of chest pain.
explanation: >-
This directly supports transient ST-segment elevation during chest-pain
attacks.
- category: Cardiovascular
name: Syncope
description: >-
Syncope can occur during ischemic episodes, usually when coronary spasm
precipitates severe bradyarrhythmia or ventricular tachyarrhythmia.
phenotype_term:
preferred_term: Syncope
term:
id: HP:0001279
label: Syncope
evidence:
- reference: PMID:21389642
reference_title: "Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Other important clinical features of variant angina include the high
frequency of asymptomatic ischemic episodes and the syncope that sometimes
occur during the ischemic episodes.
explanation: >-
This supports syncope as a clinical feature during ischemic vasospastic
episodes.
- category: Cardiovascular
name: Ventricular arrhythmia
description: >-
Ischemic attacks from coronary spasm can precipitate ventricular tachycardia
or ventricular fibrillation.
phenotype_term:
preferred_term: Ventricular arrhythmia
term:
id: HP:0004308
label: Ventricular arrhythmia
evidence:
- reference: PMID:21389642
reference_title: "Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Syncope is due to severe arrhythmias, including ventricular tachycardia,
ventricular fibrillation, and high-degree atrioventricular block.
explanation: >-
This directly supports severe ventricular arrhythmias as complications of
vasospastic ischemic episodes.
- category: Cardiovascular
name: Myocardial infarction
description: Prolonged or severe coronary spasm can cause acute myocardial infarction.
phenotype_term:
preferred_term: Myocardial infarction
term:
id: HP:0001658
label: Myocardial infarction
evidence:
- reference: PMID:41628227
reference_title: Coronary artery spasm in cardiac arrest survivors.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Clinically significant complications include myocardial infarction,
ventricular arrhythmias, and sudden cardiac arrest.
explanation: >-
This supports myocardial infarction as a clinically significant
complication of coronary artery spasm.
- category: Cardiovascular
name: Sudden cardiac arrest
description: Severe coronary spasm can precipitate sudden cardiac arrest, usually through malignant ventricular arrhythmia.
phenotype_term:
preferred_term: Cardiac arrest
term:
id: HP:0001695
label: Cardiac arrest
evidence:
- reference: PMID:41628227
reference_title: Coronary artery spasm in cardiac arrest survivors.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Coronary artery spasm can be life-threatening.
explanation: >-
This supports the life-threatening severity of coronary artery spasm in the
cardiac-arrest survivor context.
- reference: PMID:41628227
reference_title: Coronary artery spasm in cardiac arrest survivors.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
A high recurrence rate (up to 45%) of life-threatening ventricular
arrhythmias was reported, and implantable cardioverter-defibrillator
placement varied markedly.
explanation: >-
This supports recurrent life-threatening arrhythmia risk after
spasm-associated cardiac arrest.
genetic:
- name: RNF213 rs112735431 susceptibility locus
association: Susceptibility allele for vasospastic angina in Japanese cohorts
relationship_type: SUSCEPTIBILITY
gene_term:
preferred_term: RNF213
term:
id: hgnc:14539
label: RNF213
variants:
- name: rs112735431
description: East Asian-specific rare deleterious RNF213 p.Arg4810Lys variant associated with vasospastic angina.
features: >-
East Asian-specific rare deleterious variant p.Arg4810Lys was the leading
RNF213 candidate variant in the genome-wide association study.
evidence:
- reference: PMID:38888930
reference_title: "RNF213 Variants, Vasospastic Angina, and Risk of Fatal Myocardial Infarction."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The variants at the RNF213 locus showed the strongest association with VSA
across the 3 datasets
explanation: >-
This GWAS supports RNF213 as a susceptibility locus for vasospastic
angina/coronary vasospasm.
- reference: PMID:38888930
reference_title: "RNF213 Variants, Vasospastic Angina, and Risk of Fatal Myocardial Infarction."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Results of this study suggest that vascular cell dysfunction mediated by
variants in the RNF213 locus may promote coronary vasospasm, and the
presence of the risk allele could serve as a predictive factor for the
prognosis.
explanation: >-
This supports a vascular-cell dysfunction interpretation and prognostic
role for the RNF213 risk allele.
environmental:
- name: Tobacco smoking exposure
presence: Positive
description: >-
Smoking is a recognized risk factor and likely promotes vasospasm through
endothelial dysfunction, oxidative stress, inflammation, and increased smooth
muscle reactivity.
exposure_term:
preferred_term: Tobacco smoking exposure
term:
id: ECTO:6000029
label: exposure to tobacco smoking
evidence:
- reference: PMID:20049135
reference_title: Recent insights into the mechanisms of vasospastic angina.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Smoking, polymorphysms of endothelial nitric oxide synthetase (eNOS), and
low-grade inflammation have been regarded as the most important risk
factors for vasospastic angina.
explanation: >-
This review directly identifies smoking among the major risk factors for
vasospastic angina.
diagnosis:
- name: Coronary reactivity testing with acetylcholine provocation
description: >-
Invasive coronary reactivity testing with intracoronary acetylcholine can
reproduce symptoms, ischemic ECG changes, and angiographic epicardial spasm,
or support microvascular spasm when symptoms and ECG changes occur without
epicardial narrowing.
diagnosis_term:
preferred_term: X-ray coronary angiography procedure
term:
id: MAXO:0001319
label: X-ray coronary angiography procedure
results: Reversible epicardial coronary narrowing or microvascular spasm physiology supports diagnosis.
evidence:
- reference: PMID:39493950
reference_title: Invasive Evaluation for Coronary Vasospasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
The diagnosis is made with invasive coronary reactivity testing with
provocation using acetylcholine (Ach).
explanation: >-
This supports acetylcholine provocation testing as the diagnostic method
for coronary vasospasm.
- reference: PMID:39493950
reference_title: Invasive Evaluation for Coronary Vasospasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Epicardial spasms can be visualized through coronary angiography as a
reversible epicardial vessel narrowing, while the diagnosis of
microvascular spasm can be made when angina symptoms and ECG changes happen
following intracoronary Ach without epicardial spasm.
explanation: >-
This distinguishes angiographic epicardial spasm from microvascular spasm
during acetylcholine testing.
- name: Intracoronary physiology during spasm provocation
description: >-
Coronary blood flow and resistance measurements during acetylcholine testing
can add objective physiologic support for coronary spasm.
diagnosis_term:
preferred_term: coronary angiography
term:
id: MAXO:0001319
label: X-ray coronary angiography procedure
results: A fall in coronary blood flow and rise in coronary resistance during acetylcholine support spasm physiology.
evidence:
- reference: PMID:37195455
reference_title: Characterization and implications of intracoronary hemodynamic assessment during coronary spasm provocation testing.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
While a decrease in CBF and an increase in CR during ACh seem
pathognomonic for spasm, some patients with coronary spasm demonstrate
paradoxical ACh response demanding further scientific investigations.
explanation: >-
This supports decreased coronary blood flow and increased coronary
resistance as objective physiology during acetylcholine-induced spasm.
treatments:
- name: Calcium channel blocker therapy
description: Calcium channel blockers are first-line pharmacotherapy to suppress coronary artery spasm.
treatment_term:
preferred_term: Pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
evidence:
- reference: PMID:37456765
reference_title: Management of Coronary Artery Spasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Calcium channel blockers (CCBs) are the first-line treatment for coronary
artery spasm (CAS).
explanation: >-
This supports calcium channel blockers as first-line treatment.
- name: Nitrate or nicorandil add-on therapy
description: >-
Long-acting nitrates or nicorandil can be added when calcium channel blocker
therapy does not adequately control CAS-related angina.
treatment_term:
preferred_term: Pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
evidence:
- reference: PMID:37456765
reference_title: Management of Coronary Artery Spasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
When CAS-related angina symptoms are not well controlled by CCB therapy,
long-acting nitrates or (where available) nicorandil can be added as
second-line medications.
explanation: >-
This supports long-acting nitrates or nicorandil as second-line add-on
pharmacotherapy.
- name: Refractory coronary spasm therapy
description: >-
Refractory CAS may require alternative pharmacologic or procedural
approaches, including Rho-kinase inhibition where available, anti-adrenergic
therapy, neural therapies, or percutaneous intervention in selected cases.
treatment_term:
preferred_term: Pharmacotherapy
term:
id: NCIT:C15986
label: Pharmacotherapy
evidence:
- reference: PMID:37456765
reference_title: Management of Coronary Artery Spasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In the case of CAS refractory to standard treatments, several other
alternative drugs and interventions have been proposed, including the
Rho-kinase inhibitor fasudil, anti-adrenergic drugs, neural therapies and
percutaneous coronary interventions.
explanation: >-
This supports a refractory-disease treatment category after standard
vasodilator therapy.
- name: Implantable cardioverter-defibrillator placement for high-risk arrhythmia
description: >-
ICD placement is considered for selected patients with syncope or cardiac
arrest from CAS-related tachyarrhythmia after weighing recurrence risk and
response to vasodilator therapy.
treatment_term:
preferred_term: implantable cardioverter-defibrillator placement
term:
id: MAXO:0000474
label: implantable cardioverter-defibrillator placement
target_phenotypes:
- preferred_term: Ventricular arrhythmia
term:
id: HP:0004308
label: Ventricular arrhythmia
- preferred_term: Cardiac arrest
term:
id: HP:0001695
label: Cardiac arrest
evidence:
- reference: PMID:37456765
reference_title: Management of Coronary Artery Spasm.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In patients with syncope or cardiac arrest caused by CAS-related
tachyarrhythmias, or even bradyarrhythmias, implantation of an ICD or
pacemaker, respectively, should be considered according to the risk of
recurrence and efficacy of vasodilator therapy.
explanation: >-
This supports ICD consideration in high-risk CAS-related tachyarrhythmia
and cardiac-arrest contexts.
datasets:
Question: You are an expert researcher providing comprehensive, well-cited information.
Provide detailed information focusing on: 1. Key concepts and definitions with current understanding 2. Recent developments and latest research (prioritize 2023-2024 sources) 3. Current applications and real-world implementations 4. Expert opinions and analysis from authoritative sources 5. Relevant statistics and data from recent studies
Format as a comprehensive research report with proper citations. Include URLs and publication dates where available. Always prioritize recent, authoritative sources and provide specific citations for all major claims.
Please provide a comprehensive research report on Coronary Vasospasm covering all of the disease characteristics listed below. This report will be used to populate a disease knowledge base entry. Be thorough and cite primary literature (PMID preferred) for all claims.
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For symptoms/signs: HPO, OMIM, Orphanet, PubMed For behavioral changes: HPO, DSM, RDoC (Research Domain Criteria), PubMed For laboratory abnormalities: LOINC, SNOMED CT, LabTests Online, PubMed - Phenotype characteristics: Search first: OMIM, Orphanet, HPO, PubMed - Age of symptom onset (neonatal, childhood, adult-onset, late-onset) - Symptom severity (mild, moderate, severe, variable) - Symptom progression (stable, progressive, episodic, fluctuating) - Frequency among affected individuals (percentage or qualitative) - Quality of life impact: Effects on daily functioning and well-being (per-phenotype when possible) Search first: EQ-5D database, SF-36, WHO QOL databases, PubMed - Suggest HPO (Human Phenotype Ontology) terms for each phenotype
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This report will be used to populate a disease knowledge base entry with: - Pathophysiology descriptions with causal chains - Gene/protein annotations (HGNC, GO terms) - Phenotype associations (HP terms) with frequencies - Cell type involvement (CL terms) - Anatomical locations (UBERON terms) - Chemical entities (CHEBI terms) - Treatment annotations (MAXO terms) - Evidence items with PMIDs and exact abstract quotes - Epidemiology, prognosis, diagnostic, and prevention information - Animal model descriptions with phenotype recapitulation details
Coronary vasospasm (CAS) is a transient, often reversible, hyperconstriction of epicardial coronary arteries and/or the coronary microcirculation that can cause myocardial ischemia ranging from angina to acute coronary syndrome (ACS), myocardial infarction with non‑obstructive coronary arteries (MINOCA), malignant arrhythmias, syncope, and sudden cardiac death. Contemporary frameworks treat epicardial vasospastic angina (VSA) and microvascular spasm as related but distinct endotypes within angina/ischemia with non‑obstructive coronary arteries (ANOCA/INOCA). (jenkins2024vasospasticanginaa pages 1-1, lanza2023managementofcoronary pages 1-2, huang2023invasiveevaluationfor pages 3-4)
| Topic | Key data (with numbers and thresholds) | Population/Context | Source (first author, year, journal) | URL | Evidence type |
|---|---|---|---|---|---|
| Prevalence | Epicardial spasm prevalence 43% (range 16–73%); microvascular spasm 25% (range 7–39%) (woudstra2023metaanalysisandsystematic pages 9-10, woudstra2023metaanalysisandsystematic pages 1-2) | ANOCA patients; 25 studies, N=14,554, mean age 58.2 y, 44.2% women (woudstra2023metaanalysisandsystematic pages 1-2, woudstra2023metaanalysisandsystematic pages 2-4) | Woudstra, 2023, Frontiers in Cardiovascular Medicine | https://doi.org/10.3389/fcvm.2023.1129159 | Systematic review/meta-analysis |
| Recent-study prevalence | In studies published in the prior 5 years, overall CAS prevalence about 50% (95% CI 36–64%) (woudstra2023metaanalysisandsystematic pages 2-4) | Heterogeneous ANOCA/CAS literature with mixed protocols/criteria | Woudstra, 2023, Frontiers in Cardiovascular Medicine | https://doi.org/10.3389/fcvm.2023.1129159 | Systematic review/meta-analysis |
| Region differences | Epicardial spasm more frequent in Asian vs Western cohorts: 52% vs 33% (p=0.014); microvascular spasm approximately 20% vs 33%, difference not statistically significant (woudstra2023metaanalysisandsystematic pages 9-10, woudstra2023metaanalysisandsystematic pages 6-8) | ANOCA cohorts undergoing provocative testing | Woudstra, 2023, Frontiers in Cardiovascular Medicine | https://doi.org/10.3389/fcvm.2023.1129159 | Systematic review/meta-analysis |
| Sex differences | Men more likely to have epicardial spasm (61% of epicardial spasm patients male); women more likely to have microvascular spasm (64% female) (woudstra2023metaanalysisandsystematic pages 9-10, woudstra2023metaanalysisandsystematic pages 1-2, woudstra2023metaanalysisandsystematic pages 11-12) | ANOCA/CAS cohorts | Woudstra, 2023, Frontiers in Cardiovascular Medicine | https://doi.org/10.3389/fcvm.2023.1129159 | Systematic review/meta-analysis |
| Risk-factor profile | In epicardial spasm cohorts: smoking about 49%, dyslipidaemia 47%, diabetes 17%, hypertension 47% (woudstra2023metaanalysisandsystematic pages 8-9) | Epicardial spasm patients from pooled ANOCA studies | Woudstra, 2023, Frontiers in Cardiovascular Medicine | https://doi.org/10.3389/fcvm.2023.1129159 | Systematic review/meta-analysis |
| Recurrence/prognosis | Recurrent angina reported in 10–53% during follow-up; examples include 17% rehospitalisation for repeated angina, 21% persistent angina, 53% angina recurrence in one cohort (woudstra2023metaanalysisandsystematic pages 9-10, woudstra2023metaanalysisandsystematic pages 1-2, woudstra2023metaanalysisandsystematic pages 8-9) | Follow-up across CAS/epicardial spasm cohorts | Woudstra, 2023, Frontiers in Cardiovascular Medicine | https://doi.org/10.3389/fcvm.2023.1129159 | Systematic review/meta-analysis |
| MACE/MI burden | MACE reported in 268 patients (12%) with epicardial spasm; one cohort reported 5% MACE, with 90% of events due to unstable angina hospitalization; MI incidence reported across 8 studies (n=4,737) over 1–11.7 years (woudstra2023metaanalysisandsystematic pages 9-10, woudstra2023metaanalysisandsystematic pages 8-9) | Long-term follow-up in epicardial spasm/CAS cohorts | Woudstra, 2023, Frontiers in Cardiovascular Medicine | https://doi.org/10.3389/fcvm.2023.1129159 | Systematic review/meta-analysis |
| Severe complications | CAS-related cardiac arrest reported in 3.5% (7/202) of one Caucasian variant angina series and 2.4% (35/1,429) of one Japanese VSA series (lanza2023managementofcoronary pages 6-6) | Variant angina/VSA case series | Lanza, 2023, European Cardiology Review | https://doi.org/10.15420/ecr.2022.47 | Narrative review |
| Natural history timing | Up to 75% of acute events, including sudden death, occur within the first 1–3 months after symptom onset (lanza2023managementofcoronary pages 2-3) | CAS/VSA natural history | Lanza, 2023, European Cardiology Review | https://doi.org/10.15420/ecr.2022.47 | Narrative review |
| Clinical definition/synonyms | VSA = chest pain from myocardial ischemia due to epicardial coronary spasm; synonymous terms include Prinzmetal angina and variant angina; transient spasm may cause episodic chest pain, persistent spasm may cause MI (jenkins2024vasospasticanginaa pages 1-1, lanza2023managementofcoronary pages 1-2) | Disease overview/clinical practice | Jenkins, 2024, Therapeutic Advances in Cardiovascular Disease | https://doi.org/10.1177/17539447241230400 | Review |
| Diagnostic criteria: epicardial spasm | COVADIS/consensus criteria: nitrate-responsive angina plus either transient ischemic ECG changes or coronary spasm documentation; definitive epicardial spasm on provocation requires reproduction of symptoms, ischemic ECG changes, and ≥90% epicardial constriction/total or subtotal occlusion (huang2023invasiveevaluationfor pages 3-4, marchini2024sheddinglighton pages 3-5) | Invasive provocative testing with ACh/ergonovine | Huang, 2023, US Cardiology Review; Marchini, 2024, Cardiovascular Drugs and Therapy | https://doi.org/10.15420/usc.2022.33 ; https://doi.org/10.1007/s10557-022-07351-x | Review/systematic review |
| Diagnostic criteria: ECG thresholds | Transient ischemic ECG criteria include ST elevation or depression ≥0.1 mV in ≥2 contiguous leads; new negative U waves also accepted in COVADIS-based criteria (marchini2024sheddinglighton pages 3-5) | Provoked or spontaneous ischemic episodes | Marchini, 2024, Cardiovascular Drugs and Therapy | https://doi.org/10.1007/s10557-022-07351-x | Systematic review |
| Diagnostic criteria: microvascular spasm | Microvascular spasm defined by typical angina and ischemic ECG changes during intracoronary ACh without epicardial spasm/no overt epicardial constriction on angiography (huang2023invasiveevaluationfor pages 3-4, gurgoglione2024coronaryspasmtesting pages 5-7, marchini2024sheddinglighton pages 3-5) | Invasive coronary reactivity testing | Huang, 2023, US Cardiology Review; Gurgoglione, 2024, Life | https://doi.org/10.15420/usc.2022.33 ; https://doi.org/10.3390/life14030292 | Review |
| Diagnostic protocol | Typical ACh protocol: LCA 20–50–100 µg (some centers add 200 µg), RCA 20–50 µg; ECG every 30 s; angiography 1 min after each injection or with symptoms/ischemic changes (gurgoglione2024coronaryspasmtesting pages 5-7, gurgoglione2024coronaryspasmtesting media 871e19c7) | Contemporary invasive provocative testing | Gurgoglione, 2024, Life | https://doi.org/10.3390/life14030292 | Review |
| Testing enhancement | Adding 200 µg ACh in the LCA increased positive-test rate 40.9% vs 19.3%, with specificity still about 90% and no major complications reported in the cited series (gurgoglione2024coronaryspasmtesting pages 5-7) | High-dose LCA ACh strategy | Gurgoglione, 2024, Life | https://doi.org/10.3390/life14030292 | Review |
| Testing safety | Early serious complication rates 0.3–0.4%; life-threatening arrhythmias 0.5–0.6% in experienced Eastern centers; systematic review overall ACh side effects about 0.5%; one meta-analysis found major complications 1.09% and minor complications 5.87% with ACh; ACh-related death not reported (gurgoglione2024coronaryspasmtesting pages 9-10) | Intracoronary ACh provocation testing | Gurgoglione, 2024, Life | https://doi.org/10.3390/life14030292 | Review |
| Testing safety in real-world trial planning | Additional ACh test after spinal cord stimulator implantation described as having severe cardiac complication risk 0–0.7%, comparable to coronary angiography with FFR measurement (NCT06176391 chunk 1) | Prospective pilot study in refractory VSA | Wille/Amsterdam UMC, 2023 registry entry, ClinicalTrials.gov (NCT06176391) | https://clinicaltrials.gov/study/NCT06176391 | Clinical trial registry |
| Genetics: RNF213 | GWAS identified RNF213 locus as top VSA signal; overall OR 2.34 (95% CI 1.99–2.74, P=4.4×10^-25); lead variant rs112735431 p.Arg4810Lys OR 2.18 (95% CI 1.83–2.59, P=2.0×10^-18); homozygotes OR 18.34 (95% CI 5.15–65.22) (hikino2024rnf213variantsvasospastic pages 3-4, hikino2024rnf213variantsvasospastic pages 1-2, hikino2024rnf213variantsvasospastic pages 4-4) | Japanese GWAS/meta-analysis; East Asian-specific rare missense allele | Hikino, 2024, JAMA Cardiology | https://doi.org/10.1001/jamacardio.2024.1483 | GWAS/genetic association study |
| Genetics and fatal MI risk | Among carriers without baseline CAD, RNF213 rs112735431 associated with acute MI mortality during follow-up: HR 2.71 (95% CI 1.57–4.65, P=3.3×10^-4) (hikino2024rnf213variantsvasospastic pages 1-2) | Registry follow-up linked to genetic study | Hikino, 2024, JAMA Cardiology | https://doi.org/10.1001/jamacardio.2024.1483 | GWAS/genetic association study |
| Ongoing real-world implementation | BELmicro registry plans to enroll 650 patients to measure real-world frequency of coronary microvascular dysfunction and/or coronary artery vasospasm and track 1-year and 3-year MACE (NCT06089031 chunk 1) | Prospective Belgian multicenter registry of coronary function testing | University Hospital Antwerp, 2023 registry entry, ClinicalTrials.gov (NCT06089031) | https://clinicaltrials.gov/study/NCT06089031 | Clinical trial registry |
Table: This table compiles the main quantitative findings on epidemiology, prognosis, diagnostic thresholds, safety, and recent genetics for coronary vasospasm/vasospastic angina. It is designed as a quick-reference evidence summary for knowledge-base curation and report writing.
This report integrates (i) aggregated disease-level evidence from systematic reviews and narrative reviews and (ii) clinical trial registry metadata (ClinicalTrials.gov) describing real-world diagnostic implementation and ongoing trials. (woudstra2023metaanalysisandsystematic pages 1-2, lanza2023managementofcoronary pages 6-6, NCT05618132 chunk 1)
CAS/VSA is generally understood as a vasomotor disorder driven by the convergence of: 1) Endothelial dysfunction (impaired NO/vasodilator signaling with relative excess of vasoconstrictors), and 2) Vascular smooth muscle cell (VSMC) hyperreactivity/hypercontraction, prominently involving RhoA/Rho‑kinase (ROCK)–mediated calcium sensitization. (gurgoglione2024coronaryspasmtesting pages 2-4, godo2023coronarymicrovascularspasm pages 3-4, nishimiya2023mechanismsofcoronary pages 2-3)
From ANOCA cohorts undergoing spasm testing, common cardiovascular risk factors in epicardial spasm populations include smoking, dyslipidaemia, diabetes, and hypertension (approximate pooled prevalences listed in the evidence table). (woudstra2023metaanalysisandsystematic pages 8-9)
Common triggers discussed in modern reviews include stress-related autonomic surges and vasoactive exposures (e.g., cocaine, alcohol) and metabolic contributors such as magnesium deficiency. (jenkins2024vasospasticanginaa pages 1-3, huang2023invasiveevaluationfor pages 2-3, elsabbagh2024coronaryarteryspasm—risk pages 5-7)
Protective factors are not well quantified in the retrieved evidence. Mechanistically, preservation of endothelial NO signaling would be expected to be protective, and clinical use of vasodilators (CCBs) is foundational for preventing attacks. (huang2023invasiveevaluationfor pages 7-8, lanza2023managementofcoronary pages 6-6)
Reviews emphasize that genetic susceptibility (e.g., NO/ALDH2 pathways) may interact with exposures that increase oxidative stress and ROCK activity, notably smoking and stress, to increase spasm propensity. (gurgoglione2024coronaryspasmtesting pages 2-4, elsabbagh2024coronaryarteryspasm—risk pages 7-8)
Symptoms / clinical signs * Angina at rest often with a circadian pattern (e.g., early morning), classically in variant angina, though exertional or stress-triggered episodes also occur. (lanza2023managementofcoronary pages 1-2, jenkins2024vasospasticanginaa pages 1-3) * Transient ischemic ECG changes during attacks, including ST-segment elevation (classic) but also ST depression and T-wave changes. (jenkins2024vasospasticanginaa pages 1-1, lanza2023managementofcoronary pages 1-2)
Complications / severe phenotypes * Acute MI / ACS / MINOCA can occur when spasm is prolonged; reviews explicitly note that persistent spasm can lead to MI. (jenkins2024vasospasticanginaa pages 1-1) * Syncope and sudden cardiac death: VSA is associated with major adverse events including “sudden cardiac death, acute MI and syncope.” (jenkins2024vasospasticanginaa pages 1-1)
(These HPO identifiers are suggested for knowledge-base normalization; they are not explicitly enumerated in the retrieved papers.)
A 2024 genetic association study identified RNF213 as a major susceptibility locus for VSA: * Overall association at RNF213 locus: OR 2.34 (95% CI 1.99–2.74; P=4.4×10−25). (hikino2024rnf213variantsvasospastic pages 1-2) * Lead variant rs112735431 (p.Arg4810Lys): OR 2.18 (95% CI 1.83–2.59; P=2.0×10−18); homozygotes showed a much larger effect (OR 18.34). (hikino2024rnf213variantsvasospastic pages 3-4, hikino2024rnf213variantsvasospastic pages 1-2) * Importantly, in follow-up among carriers without baseline CAD, this allele was associated with increased acute MI mortality: HR 2.71 (95% CI 1.57–4.65; P=3.3×10−4). (hikino2024rnf213variantsvasospastic pages 1-2)
Mechanistic/risk-factor reviews cite associations involving: * ALDH2 East Asian variant (associated with coronary spastic angina) (elsabbagh2024coronaryarteryspasm—risk pages 7-8) * NOS3/eNOS: T−786→C promoter variant “associated with coronary spasm” (elsabbagh2024coronaryarteryspasm—risk pages 7-8) * ACE variants described as a genetic risk factor for coronary spasm with implication in MI pathogenesis (elsabbagh2024coronaryarteryspasm—risk pages 7-8) * Paraoxonase polymorphism (Q192R) and PLC-δ1 variant (R257H) noted in review-level summaries (elsabbagh2024coronaryarteryspasm—risk pages 5-7, elsabbagh2024coronaryarteryspasm—risk pages 7-8)
Variant classification / allele frequencies: not available from the retrieved texts; curated variant-level annotation would require ClinVar/gnomAD retrieval.
Core signaling nodes repeatedly emphasized: * NO–cGMP signaling (endothelium → VSMC) (gurgoglione2024coronaryspasmtesting pages 2-4) * Endothelin‑1 and other vasoconstrictors (gurgoglione2024coronaryspasmtesting pages 2-4, huang2023invasiveevaluationfor pages 2-3) * RhoA/ROCK → myosin phosphatase inhibition → increased MLC phosphorylation → VSMC hypercontraction (nishimiya2023mechanismsofcoronary pages 2-3, gurgoglione2024coronaryspasmtesting pages 19-20)
Environmental/lifestyle contributors commonly referenced include smoking (oxidative stress/inflammation), stress/catecholamine surges, and vasoactive substances (e.g., cocaine, alcohol). (huang2023invasiveevaluationfor pages 2-3, jenkins2024vasospasticanginaa pages 1-3)
A consistent mechanistic chain described across modern reviews is: 1) Endothelial dysfunction → reduced NO bioavailability and impaired ACh-mediated vasodilation, allowing paradoxical vasoconstriction. (gurgoglione2024coronaryspasmtesting pages 2-4, huang2023invasiveevaluationfor pages 2-3) 2) ROCK-mediated Ca2+ sensitization in VSMCs → myosin phosphatase inhibition → increased myosin light-chain phosphorylation → hypercontraction. (nishimiya2023mechanismsofcoronary pages 2-3, gurgoglione2024coronaryspasmtesting pages 19-20) 3) Clinical spasm (epicardial and/or microvascular) → transient ischemia → angina/ECG changes; prolonged or severe episodes → arrhythmia, MI, cardiac arrest. (lanza2023managementofcoronary pages 1-2, jenkins2024vasospasticanginaa pages 1-1)
(These ontology terms are suggested for normalization; the reviews describe these cell types but do not enumerate ontology IDs.) (godo2023coronarymicrovascularspasm pages 3-4, nishimiya2023mechanismsofcoronary pages 1-2)
A 2023 systematic review/meta-analysis of ANOCA patients undergoing spasm provocation testing reported: * Epicardial spasm prevalence 43% (range 16–73%), and microvascular spasm prevalence 25% (range 7–39%). (woudstra2023metaanalysisandsystematic pages 1-2) * Regional differences: epicardial spasm 52% in Asian vs 33% in Western cohorts (p=0.014). (woudstra2023metaanalysisandsystematic pages 1-2) * Sex differences: men more often epicardial spasm (≈61%); women more often microvascular spasm (≈64%). (woudstra2023metaanalysisandsystematic pages 1-2)
RNF213 rs112735431 is an East Asian–enriched risk allele with substantial VSA association and may stratify MI risk in carriers. (hikino2024rnf213variantsvasospastic pages 1-2)
Epicardial spasm / VSA (definitive evidence) * Nitrate-responsive angina plus objective evidence: transient ischemic ECG changes or angiographic documentation of spasm. (huang2023invasiveevaluationfor pages 3-4, marchini2024sheddinglighton pages 3-5) * During provocation, a positive test is defined by reproduction of symptoms, ischemic ECG changes, and ≥90% epicardial constriction (transient total/subtotal occlusion). (huang2023invasiveevaluationfor pages 3-4, marchini2024sheddinglighton pages 3-5)
Transient ischemic ECG thresholds (COVADIS-derived) * ST elevation ≥0.1 mV or ST depression ≥0.1 mV in ≥2 contiguous leads; negative U waves are also accepted. (marchini2024sheddinglighton pages 3-5)
Microvascular spasm * Typical symptoms and ischemic ECG changes after intracoronary ACh without epicardial spasm (no significant epicardial diameter reduction). (huang2023invasiveevaluationfor pages 3-4, marchini2024sheddinglighton pages 3-5)
Acetylcholine (ACh) provocation protocol (typical contemporary regimen) * Stepwise intracoronary dosing often uses LCA boluses 20–50–100 μg (some add 200 μg) and RCA 20–50 μg, separated by 2–3 minutes; ECG is monitored frequently and angiography performed after each dose or with symptoms/ECG changes. (gurgoglione2024coronaryspasmtesting pages 5-7)
Safety and adverse events * A 2024 review summarized that ACh testing has low but non-zero complication rates; serious complications and life‑threatening arrhythmias are rare and ACh-related death has not been reported. Quantitative safety figures summarized include early serious complication rates 0.3–0.4%, life‑threatening arrhythmias 0.5–0.6%, and meta-analytic estimates of major/minor complication frequencies. (gurgoglione2024coronaryspasmtesting pages 9-10)
Visual evidence (protocol/algorithm and protocol table) * ACh testing protocol flowchart and protocol comparison table are available from the retrieved figures/tables. (gurgoglione2024coronaryspasmtesting media 871e19c7, gurgoglione2024coronaryspasmtesting media ac042141)
In ANOCA/INOCA contexts, VSA must be distinguished from microvascular angina/CMD endotypes; invasive testing can clarify endotype for stratified therapy. (huang2023invasiveevaluationfor pages 3-4, woudstra2023metaanalysisandsystematic pages 11-12)
In ANOCA cohorts with CAS, recurrent angina is common (10–53% across studies), and MACE is often dominated by rehospitalization/unstable angina rather than death/MI in many cohorts. (woudstra2023metaanalysisandsystematic pages 1-2, woudstra2023metaanalysisandsystematic pages 9-10)
Cardiac arrest due to CAS-related ventricular tachyarrhythmias is emphasized as “the most severe complication,” with reported prevalence in illustrative cohorts (≈2–4%). (lanza2023managementofcoronary pages 6-6)
For refractory CAS, multiple alternative interventions have been proposed, including ROCK inhibition (fasudil), anti-adrenergic approaches, neural therapies, and in select cases device therapy (ICD/pacemaker) when syncope/cardiac arrest is attributable to CAS-related arrhythmias. (lanza2023managementofcoronary pages 6-6)
Across mechanistic reviews, the centrality of ROCK-mediated VSMC hypercontraction supports investigation and selective use (where available) of ROCK inhibitors and other strategies that restore endothelial NO signaling or reduce inflammation/oxidative stress as mechanistically aligned approaches. (nishimiya2023mechanismsofcoronary pages 2-3, godo2023coronarymicrovascularspasm pages 3-4, gurgoglione2024coronaryspasmtesting pages 19-20)
Evidence-based prevention in retrieved texts is mainly risk-factor and trigger management consistent with mechanistic drivers (e.g., smoking avoidance, stress reduction, adherence to vasodilator therapy). Stopping vasodilator therapy can provoke recurrence; early post-onset window is high risk. (lanza2023managementofcoronary pages 2-3, gurgoglione2024coronaryspasmtesting pages 2-4)
No naturally occurring non-human disease model evidence was retrieved in this run.
Mechanistic understanding is supported by animal model literature (e.g., inflammatory IL‑1β adventitial exposure inducing spasm; ROCK inhibition suppressing spasm physiology), but explicit model-system metadata (strain, organism IDs) was not fully captured in the retrieved excerpts. (nishimiya2023mechanismsofcoronary pages 2-3)
References
(jenkins2024vasospasticanginaa pages 1-1): Kenny Jenkins, Graziella Pompei, Nandine Ganzorig, Sarah Brown, John Beltrame, and Vijay Kunadian. Vasospastic angina: a review on diagnostic approach and management. Therapeutic Advances in Cardiovascular Disease, Jan 2024. URL: https://doi.org/10.1177/17539447241230400, doi:10.1177/17539447241230400. This article has 56 citations and is from a peer-reviewed journal.
(lanza2023managementofcoronary pages 1-2): Gaetano Antonio Lanza and Hiroaki Shimokawa. Management of coronary artery spasm. European Cardiology Review, May 2023. URL: https://doi.org/10.15420/ecr.2022.47, doi:10.15420/ecr.2022.47. This article has 33 citations.
(huang2023invasiveevaluationfor pages 3-4): Jingwen Huang, Rebecca Steinberg, Matthew J Brown, Stéphane Rinfret, and Olga Toleva. Invasive evaluation for coronary vasospasm. US Cardiology Review, Jun 2023. URL: https://doi.org/10.15420/usc.2022.33, doi:10.15420/usc.2022.33. This article has 5 citations.
(woudstra2023metaanalysisandsystematic pages 9-10): Janneke Woudstra, Caitlin E. M. Vink, Diantha J. M. Schipaanboord, Etto C. Eringa, Hester M. den Ruijter, Rutger G. T. Feenstra, Coen K. M. Boerhout, Marcel A. M. Beijk, Guus A. de Waard, Peter Ong, Andreas Seitz, Udo Sechtem, Jan J. Piek, Tim P. van de Hoef, and Yolande Appelman. Meta-analysis and systematic review of coronary vasospasm in anoca patients: prevalence, clinical features and prognosis. Frontiers in Cardiovascular Medicine, Mar 2023. URL: https://doi.org/10.3389/fcvm.2023.1129159, doi:10.3389/fcvm.2023.1129159. This article has 26 citations and is from a peer-reviewed journal.
(woudstra2023metaanalysisandsystematic pages 1-2): Janneke Woudstra, Caitlin E. M. Vink, Diantha J. M. Schipaanboord, Etto C. Eringa, Hester M. den Ruijter, Rutger G. T. Feenstra, Coen K. M. Boerhout, Marcel A. M. Beijk, Guus A. de Waard, Peter Ong, Andreas Seitz, Udo Sechtem, Jan J. Piek, Tim P. van de Hoef, and Yolande Appelman. Meta-analysis and systematic review of coronary vasospasm in anoca patients: prevalence, clinical features and prognosis. Frontiers in Cardiovascular Medicine, Mar 2023. URL: https://doi.org/10.3389/fcvm.2023.1129159, doi:10.3389/fcvm.2023.1129159. This article has 26 citations and is from a peer-reviewed journal.
(woudstra2023metaanalysisandsystematic pages 2-4): Janneke Woudstra, Caitlin E. M. Vink, Diantha J. M. Schipaanboord, Etto C. Eringa, Hester M. den Ruijter, Rutger G. T. Feenstra, Coen K. M. Boerhout, Marcel A. M. Beijk, Guus A. de Waard, Peter Ong, Andreas Seitz, Udo Sechtem, Jan J. Piek, Tim P. van de Hoef, and Yolande Appelman. Meta-analysis and systematic review of coronary vasospasm in anoca patients: prevalence, clinical features and prognosis. Frontiers in Cardiovascular Medicine, Mar 2023. URL: https://doi.org/10.3389/fcvm.2023.1129159, doi:10.3389/fcvm.2023.1129159. This article has 26 citations and is from a peer-reviewed journal.
(woudstra2023metaanalysisandsystematic pages 6-8): Janneke Woudstra, Caitlin E. M. Vink, Diantha J. M. Schipaanboord, Etto C. Eringa, Hester M. den Ruijter, Rutger G. T. Feenstra, Coen K. M. Boerhout, Marcel A. M. Beijk, Guus A. de Waard, Peter Ong, Andreas Seitz, Udo Sechtem, Jan J. Piek, Tim P. van de Hoef, and Yolande Appelman. Meta-analysis and systematic review of coronary vasospasm in anoca patients: prevalence, clinical features and prognosis. Frontiers in Cardiovascular Medicine, Mar 2023. URL: https://doi.org/10.3389/fcvm.2023.1129159, doi:10.3389/fcvm.2023.1129159. This article has 26 citations and is from a peer-reviewed journal.
(woudstra2023metaanalysisandsystematic pages 11-12): Janneke Woudstra, Caitlin E. M. Vink, Diantha J. M. Schipaanboord, Etto C. Eringa, Hester M. den Ruijter, Rutger G. T. Feenstra, Coen K. M. Boerhout, Marcel A. M. Beijk, Guus A. de Waard, Peter Ong, Andreas Seitz, Udo Sechtem, Jan J. Piek, Tim P. van de Hoef, and Yolande Appelman. Meta-analysis and systematic review of coronary vasospasm in anoca patients: prevalence, clinical features and prognosis. Frontiers in Cardiovascular Medicine, Mar 2023. URL: https://doi.org/10.3389/fcvm.2023.1129159, doi:10.3389/fcvm.2023.1129159. This article has 26 citations and is from a peer-reviewed journal.
(woudstra2023metaanalysisandsystematic pages 8-9): Janneke Woudstra, Caitlin E. M. Vink, Diantha J. M. Schipaanboord, Etto C. Eringa, Hester M. den Ruijter, Rutger G. T. Feenstra, Coen K. M. Boerhout, Marcel A. M. Beijk, Guus A. de Waard, Peter Ong, Andreas Seitz, Udo Sechtem, Jan J. Piek, Tim P. van de Hoef, and Yolande Appelman. Meta-analysis and systematic review of coronary vasospasm in anoca patients: prevalence, clinical features and prognosis. Frontiers in Cardiovascular Medicine, Mar 2023. URL: https://doi.org/10.3389/fcvm.2023.1129159, doi:10.3389/fcvm.2023.1129159. This article has 26 citations and is from a peer-reviewed journal.
(lanza2023managementofcoronary pages 6-6): Gaetano Antonio Lanza and Hiroaki Shimokawa. Management of coronary artery spasm. European Cardiology Review, May 2023. URL: https://doi.org/10.15420/ecr.2022.47, doi:10.15420/ecr.2022.47. This article has 33 citations.
(lanza2023managementofcoronary pages 2-3): Gaetano Antonio Lanza and Hiroaki Shimokawa. Management of coronary artery spasm. European Cardiology Review, May 2023. URL: https://doi.org/10.15420/ecr.2022.47, doi:10.15420/ecr.2022.47. This article has 33 citations.
(marchini2024sheddinglighton pages 3-5): Federico Marchini, Graziella Pompei, Emanuele D’Aniello, Andrea Marrone, Serena Caglioni, Simone Biscaglia, Gianluca Campo, and Matteo Tebaldi. Shedding light on treatment options for coronary vasomotor disorders: a systematic review. Cardiovascular Drugs and Therapy, 38:151-161, Jun 2024. URL: https://doi.org/10.1007/s10557-022-07351-x, doi:10.1007/s10557-022-07351-x. This article has 10 citations and is from a peer-reviewed journal.
(gurgoglione2024coronaryspasmtesting pages 5-7): Filippo Luca Gurgoglione, Luigi Vignali, Rocco Antonio Montone, Riccardo Rinaldi, Giorgio Benatti, Emilia Solinas, Antonio Maria Leone, Domenico Galante, Gianluca Campo, Simone Biscaglia, Italo Porto, Stefano Benenati, and Giampaolo Niccoli. Coronary spasm testing with acetylcholine: a powerful tool for a personalized therapy of coronary vasomotor disorders. Life, 14:292, Feb 2024. URL: https://doi.org/10.3390/life14030292, doi:10.3390/life14030292. This article has 16 citations.
(gurgoglione2024coronaryspasmtesting media 871e19c7): Filippo Luca Gurgoglione, Luigi Vignali, Rocco Antonio Montone, Riccardo Rinaldi, Giorgio Benatti, Emilia Solinas, Antonio Maria Leone, Domenico Galante, Gianluca Campo, Simone Biscaglia, Italo Porto, Stefano Benenati, and Giampaolo Niccoli. Coronary spasm testing with acetylcholine: a powerful tool for a personalized therapy of coronary vasomotor disorders. Life, 14:292, Feb 2024. URL: https://doi.org/10.3390/life14030292, doi:10.3390/life14030292. This article has 16 citations.
(gurgoglione2024coronaryspasmtesting pages 9-10): Filippo Luca Gurgoglione, Luigi Vignali, Rocco Antonio Montone, Riccardo Rinaldi, Giorgio Benatti, Emilia Solinas, Antonio Maria Leone, Domenico Galante, Gianluca Campo, Simone Biscaglia, Italo Porto, Stefano Benenati, and Giampaolo Niccoli. Coronary spasm testing with acetylcholine: a powerful tool for a personalized therapy of coronary vasomotor disorders. Life, 14:292, Feb 2024. URL: https://doi.org/10.3390/life14030292, doi:10.3390/life14030292. This article has 16 citations.
(NCT06176391 chunk 1): Frank Wille, MD. SCS for Vasospastic Angina Vasospastic Angina Pectoris - a Prospective Study. Amsterdam UMC, location VUmc. 2024. ClinicalTrials.gov Identifier: NCT06176391
(hikino2024rnf213variantsvasospastic pages 3-4): Keiko Hikino, Satoshi Koyama, Kaoru Ito, Yoshinao Koike, Masaru Koido, Takayoshi Matsumura, Ryo Kurosawa, Kohei Tomizuka, Shuji Ito, Xiaoxi Liu, Yuki Ishikawa, Yukihide Momozawa, Takayuki Morisaki, Yoichiro Kamatani, Taisei Mushiroda, Chikashi Terao, Yuji Yamanashi, Yoichi Furukawa, Yoshinori Murakami, Kaori Muto, Akiko Nagai, Wataru Obara, Ken Yamaji, Kazuhisa Takahashi, Satoshi Asai, Yasuo Takahashi, Takao Suzuki, Nobuaki Sinozaki, Hiroki Yamaguchi, Shiro Minami, Shigeo Murayama, Kozo Yoshimori, Satoshi Nagayama, Daisuke Obata, Masahiko Higashiyama, Akihide Matsumoto, and Yukihiro Koretsune. rnf213 variants, vasospastic angina, and risk of fatal myocardial infarction. JAMA Cardiology, 9:723, Aug 2024. URL: https://doi.org/10.1001/jamacardio.2024.1483, doi:10.1001/jamacardio.2024.1483. This article has 21 citations and is from a highest quality peer-reviewed journal.
(hikino2024rnf213variantsvasospastic pages 1-2): Keiko Hikino, Satoshi Koyama, Kaoru Ito, Yoshinao Koike, Masaru Koido, Takayoshi Matsumura, Ryo Kurosawa, Kohei Tomizuka, Shuji Ito, Xiaoxi Liu, Yuki Ishikawa, Yukihide Momozawa, Takayuki Morisaki, Yoichiro Kamatani, Taisei Mushiroda, Chikashi Terao, Yuji Yamanashi, Yoichi Furukawa, Yoshinori Murakami, Kaori Muto, Akiko Nagai, Wataru Obara, Ken Yamaji, Kazuhisa Takahashi, Satoshi Asai, Yasuo Takahashi, Takao Suzuki, Nobuaki Sinozaki, Hiroki Yamaguchi, Shiro Minami, Shigeo Murayama, Kozo Yoshimori, Satoshi Nagayama, Daisuke Obata, Masahiko Higashiyama, Akihide Matsumoto, and Yukihiro Koretsune. rnf213 variants, vasospastic angina, and risk of fatal myocardial infarction. JAMA Cardiology, 9:723, Aug 2024. URL: https://doi.org/10.1001/jamacardio.2024.1483, doi:10.1001/jamacardio.2024.1483. This article has 21 citations and is from a highest quality peer-reviewed journal.
(hikino2024rnf213variantsvasospastic pages 4-4): Keiko Hikino, Satoshi Koyama, Kaoru Ito, Yoshinao Koike, Masaru Koido, Takayoshi Matsumura, Ryo Kurosawa, Kohei Tomizuka, Shuji Ito, Xiaoxi Liu, Yuki Ishikawa, Yukihide Momozawa, Takayuki Morisaki, Yoichiro Kamatani, Taisei Mushiroda, Chikashi Terao, Yuji Yamanashi, Yoichi Furukawa, Yoshinori Murakami, Kaori Muto, Akiko Nagai, Wataru Obara, Ken Yamaji, Kazuhisa Takahashi, Satoshi Asai, Yasuo Takahashi, Takao Suzuki, Nobuaki Sinozaki, Hiroki Yamaguchi, Shiro Minami, Shigeo Murayama, Kozo Yoshimori, Satoshi Nagayama, Daisuke Obata, Masahiko Higashiyama, Akihide Matsumoto, and Yukihiro Koretsune. rnf213 variants, vasospastic angina, and risk of fatal myocardial infarction. JAMA Cardiology, 9:723, Aug 2024. URL: https://doi.org/10.1001/jamacardio.2024.1483, doi:10.1001/jamacardio.2024.1483. This article has 21 citations and is from a highest quality peer-reviewed journal.
(NCT06089031 chunk 1): Belgian Registry on Coronary Function Testing. University Hospital, Antwerp. 2021. ClinicalTrials.gov Identifier: NCT06089031
(huang2023invasiveevaluationfor pages 7-8): Jingwen Huang, Rebecca Steinberg, Matthew J Brown, Stéphane Rinfret, and Olga Toleva. Invasive evaluation for coronary vasospasm. US Cardiology Review, Jun 2023. URL: https://doi.org/10.15420/usc.2022.33, doi:10.15420/usc.2022.33. This article has 5 citations.
(NCT05618132 chunk 1): ReACHallenge Trial: Acetylcholine Rechallenge After Pretreatment With Vasoactive Drugs. University Hospital, Antwerp. 2023. ClinicalTrials.gov Identifier: NCT05618132
(elsabbagh2024coronaryarteryspasm—risk pages 7-8): Farah El-Sabbagh, Noha M. Mesbah, Dina M Abo-El-Matty, and Tarek A. Abdelaziz. Coronary artery spasm—risk factors and pathophysiological mechanisms. Records of Pharmaceutical and Biomedical Sciences, 8:191-198, May 2024. URL: https://doi.org/10.21608/rpbs.2024.327931.1332, doi:10.21608/rpbs.2024.327931.1332. This article has 0 citations.
(gurgoglione2024coronaryspasmtesting pages 2-4): Filippo Luca Gurgoglione, Luigi Vignali, Rocco Antonio Montone, Riccardo Rinaldi, Giorgio Benatti, Emilia Solinas, Antonio Maria Leone, Domenico Galante, Gianluca Campo, Simone Biscaglia, Italo Porto, Stefano Benenati, and Giampaolo Niccoli. Coronary spasm testing with acetylcholine: a powerful tool for a personalized therapy of coronary vasomotor disorders. Life, 14:292, Feb 2024. URL: https://doi.org/10.3390/life14030292, doi:10.3390/life14030292. This article has 16 citations.
(godo2023coronarymicrovascularspasm pages 3-4): Shigeo Godo, Jun Takahashi, Takashi Shiroto, Satoshi Yasuda, and Hiroaki Shimokawa. Coronary microvascular spasm: clinical presentation and diagnosis. European Cardiology Review, Mar 2023. URL: https://doi.org/10.15420/ecr.2022.50, doi:10.15420/ecr.2022.50. This article has 14 citations.
(nishimiya2023mechanismsofcoronary pages 2-3): Kensuke Nishimiya, Jun Takahashi, Kazuma Oyama, Yasuharu Matsumoto, Satoshi Yasuda, and Hiroaki Shimokawa. Mechanisms of coronary artery spasm. European Cardiology Review, May 2023. URL: https://doi.org/10.15420/ecr.2022.55, doi:10.15420/ecr.2022.55. This article has 18 citations.
(jenkins2024vasospasticanginaa pages 1-3): Kenny Jenkins, Graziella Pompei, Nandine Ganzorig, Sarah Brown, John Beltrame, and Vijay Kunadian. Vasospastic angina: a review on diagnostic approach and management. Therapeutic Advances in Cardiovascular Disease, Jan 2024. URL: https://doi.org/10.1177/17539447241230400, doi:10.1177/17539447241230400. This article has 56 citations and is from a peer-reviewed journal.
(huang2023invasiveevaluationfor pages 2-3): Jingwen Huang, Rebecca Steinberg, Matthew J Brown, Stéphane Rinfret, and Olga Toleva. Invasive evaluation for coronary vasospasm. US Cardiology Review, Jun 2023. URL: https://doi.org/10.15420/usc.2022.33, doi:10.15420/usc.2022.33. This article has 5 citations.
(elsabbagh2024coronaryarteryspasm—risk pages 5-7): Farah El-Sabbagh, Noha M. Mesbah, Dina M Abo-El-Matty, and Tarek A. Abdelaziz. Coronary artery spasm—risk factors and pathophysiological mechanisms. Records of Pharmaceutical and Biomedical Sciences, 8:191-198, May 2024. URL: https://doi.org/10.21608/rpbs.2024.327931.1332, doi:10.21608/rpbs.2024.327931.1332. This article has 0 citations.
(gurgoglione2024coronaryspasmtesting pages 19-20): Filippo Luca Gurgoglione, Luigi Vignali, Rocco Antonio Montone, Riccardo Rinaldi, Giorgio Benatti, Emilia Solinas, Antonio Maria Leone, Domenico Galante, Gianluca Campo, Simone Biscaglia, Italo Porto, Stefano Benenati, and Giampaolo Niccoli. Coronary spasm testing with acetylcholine: a powerful tool for a personalized therapy of coronary vasomotor disorders. Life, 14:292, Feb 2024. URL: https://doi.org/10.3390/life14030292, doi:10.3390/life14030292. This article has 16 citations.
(nishimiya2023mechanismsofcoronary pages 1-2): Kensuke Nishimiya, Jun Takahashi, Kazuma Oyama, Yasuharu Matsumoto, Satoshi Yasuda, and Hiroaki Shimokawa. Mechanisms of coronary artery spasm. European Cardiology Review, May 2023. URL: https://doi.org/10.15420/ecr.2022.55, doi:10.15420/ecr.2022.55. This article has 18 citations.
(gurgoglione2024coronaryspasmtesting media ac042141): Filippo Luca Gurgoglione, Luigi Vignali, Rocco Antonio Montone, Riccardo Rinaldi, Giorgio Benatti, Emilia Solinas, Antonio Maria Leone, Domenico Galante, Gianluca Campo, Simone Biscaglia, Italo Porto, Stefano Benenati, and Giampaolo Niccoli. Coronary spasm testing with acetylcholine: a powerful tool for a personalized therapy of coronary vasomotor disorders. Life, 14:292, Feb 2024. URL: https://doi.org/10.3390/life14030292, doi:10.3390/life14030292. This article has 16 citations.
(NCT06415227 chunk 1): Jan J. Piek, MD, PhD. The Impact of Vericiguat on Microvascular Function in Patients with Documented Vasospastic Angina Pectoris. Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA). 2025. ClinicalTrials.gov Identifier: NCT06415227