Coronary reactivity to ergonovine--possible relationship to accelerated coronary arterial disease in cardiac transplant recipients

Severe coronary artery spasm can occur in orthotopic cardiac transplant recipients. To investigate the possible mechanisms and relevance of coronary spasm to the subsequent development of coronary disease, the response of the coronary arteries to intracoronary ergonovine maleate was studied in 10 patients who had undergone orthotopic cardiac transplantation and were shown to have normal coronary arteries at angiography. Ergonovine in doses of 1, 5 and 10 micrograms was injected into the left coronary artery followed by 2 mg of isosorbide dinitrate. Proximal coronary artery luminal diameters were measured using automated computerized quantitative angiography of the left anterior descending (LAD) and circumflex (LCX) vessels. Five patients (responders) demonstrated a dose response curve to intracoronary ergonovine which was similar to that previously seen in non-transplant patients (mean percentage diameter change +/- SEM, -24.68 +/- 1.93 for LAD, -24.06 +/- 3.91 for LCX). The remaining five patients (non-responders) demonstrated a virtually flat dose response curve significantly different from that of the responders (P = 0.001 for LAD, P = 0.013 for LCX). Angiography after 2 years demonstrated significant coronary disease in four of the five responders to ergonovine. In contrast, the five non-responders to ergonovine continue to have no detectable disease by angiography.     

冠状动脉内麦角新碱激发试验的临床评价

目的 为评价冠状动脉内麦角新碱激发试验临床应用的价值。方法 17例常规冠状动脉造影未异常者，行冠状动脉内麦角新碱激发试验，用冠状动脉造影判断有无冠状动脉痉挛。结果 9例临床有拟诊冠状动脉痉挛依据者，冠状动脉内麦角新碱激发试验阳性；8例X线综合征试验阴性。结论 冠状动脉内麦角新碱激发试验敏感性高，安全性好，但也应注意并发症的发生。     

Ergonovine maleate test in various anginal syndromes

The ergonovine maleate (EM) test has been performed in fourgroups of 10 patients each: (A) variant angina; (B) angina atrest with ST segment depression during pain; (C) effort angina;(D) atypical chest i pain. EM was injected i.v. (highest dose 0-4 mg) first in the CoronaryCare Unit and thereafter during coronary angiography. EM causedcoronary spasm with angina and ST segment elevation in everypatient of group A and in one patient of group B. In five and four patients of groups B and C, respectively, EMinduced angina and ST segment depression without any localizedcoronary spasm, the coronary angiography showing only a diffusenarrowing of the coronary vessels; these patients had the lowesteffort tolerance and the most severe coronary lesions. Spontaneous or induced coronary spasm in patients with anginaat rest and ST segment depression during chest pain did notoccur in this study. An increase of the peripheral and/or coronaryresistances due to EM could be the mechanism of the ischemicattack in patients with severe coronary lesions.     

Coronary Artery Spasm

Coronary artery spasm is a transient reduction in lumen diameter of an epicardial coronary artery of sufficient degree to produce objective evidence of myocardial ischemia in the absence of any significant increase in heart rate or blood pressure. In this article are summarized pathophysiological observations, the coronary angiographic anatomy of patients with coronary spasm, etiologic considerations, methods to provoke coronary artery artery spasm and their clinical usefulness, the role of coronary artery spasm in patients with clinical angina pectoris and myocardial infarction, and finally, the role of coronary artery spasm in patients undergoing coronary artery surgery.     

麦角新碱预防高危孕产妇剖宫产出血的疗效观察

目的评估麦角新碱预防高危孕妇剖宫产术中及术后出血的有效性和安全性。 方法收集2017年2月至6月就诊于全国16家医院具有出血高危因素行剖宫产术的产妇1074例。按使用不同宫缩将患者分成3组,研究组Ⅰ(384例,术中注射缩宫素＋麦角新碱,术后注射缩宫素),研究组Ⅱ(340例,术中注射缩宫素＋麦角新碱,术后注射麦角新碱),对照组(350例,术中和术后注射缩宫素),比较各组术中、术后2 h及术后24 h出血量及药物副作用的情况。采用方差分析和χ²检验对数据进行统计学分析。 结果研究组Ⅱ术中出血量,术后2 h和术后24 h出血增量分别为(400.09±203.82)ml、(31.76±27.83)ml和(60.74±55.27)ml,明显低于研究组Ⅰ的(451.33±441.43)ml、(66.30±43.08)ml和(83.62±56.89)ml,差异均有统计学意义(P<0.05)。研究组Ⅱ使用治疗性宫缩剂为18例(5.29%),分别低于研究组Ⅰ89例(23.18%)和对照组102例(29.14%),q＝3.90和4.32,差异均有统计学意义(P<0.05)。 结论麦角新碱预防高危孕产妇剖宫产术中和术后出血安全有效,但药物不良反应要密切注意。     

Once daily felodipine in preventing ergonovine-induced myocardial ischaemia in Prinzmetal's variant angina

The efficacy of extended-release felodipine in preventing ergonovine-inducedmyocardial ischaemia was assessed in 14 patients (12 male, twofemale, aged 56±7 years) with Prinzmetal's variant angina.Four of the patients had normal coronary arteries, eight hadone-vessel and two had two-vessel disease. The ergonovine testwas performed once in basal conditions and twice 5 days afterbeginning the oral administration of felodipine 20 mg o.d.,4 and 24 h after the last administration. During a continuous6-lead ECG recording, ergonovine was injected at doses of 25,50, 100, 200, and 400 µg at 5 min intervals. Blood samplesfor felodipine plasma concentrations were drawn at the timeof the tests. The basal ergonovine test was positive in all 14 patients (sevenwith anterior and seven with inferior ST segment elevation >0•1m V) at a mean ergonovine dose of 162±138 µg. Thetest was repeated 4 h after the last felodipine administrationand was negative in 13 patients (93%), but 24 h after the lastdrug administration, eight patients (57%) had a positive testresponse (five with anterior, three with inferior ST segmentelevation) at a higher ergonovine dose than at baseline (150vs 97 µg, P=0•042). The only dtfferences betweenpatients with a negative and a positive test were the mean valuesof the left ventricular end-diastolic pressure (9•3 vs14•9 mmHg, P=0•002) and the ergonovine doses usedin the baseline tests (250 vs 97 µg, P=0•034). Themean felodipine plasma level 4 h after dosing was 18•0±12•2nmol. l^–1; 24 h post-dosing plasma concentrations weregenerally very low (<3 nmol. l^–1 in eight cases). Noacute side effects were observed during the trial. In conclusion, extended-release felodipine, given once daily,appears to be highly effective in preventing ergonovine-inducedischaemia in patients with Prinzmetal's variant angina, maintaininggood efficacy even 24 h post-dosing.     

Ergonovine stress echocardiography: Recent experience and safety in our centre

AIM: To study recent experience and safety of ergonovine stress echocardiography in our centre.METHODS: In this study we collected the clinical variables of patients referred since 2002 for ergonovine stress echocardiography, in addition to indications, the results of this test, complications, blood pressure and heart rate values during the test and the number and results of tests requested before this technique.RESULTS: We performed 40 tests in 38 patients, 2 tests were carried out to verify therapy efficacy. The prevalence of classic cardiovascular risk factors was low and the most frequent indication was chest pain (57.5%). Coronary angiography was performed in 32 patients, and showed normal coronary arteries in 27 patients and non-significant stenosis in 5 cases. In 16 patients, coronary angiography was carried out after a positive or inconclusive ischemia test. Another 6 patients had a normal stress test (5 exercise electrocardiography tests and 1 nuclear imaging test). Of the 40 ergonovine stress echocardiography tests, 6 were positive (4 in the right coronary artery territory and 2 in the circumflex coronary artery territory), all of them by echocardiographic criteria, and by electrocardiographic criteria in only 3 (50%). The presence of non-significant coronary artery stenosis was more frequent in patients with positive ergonovine stress echocardiography (50% vs 6%, P = 0.038), and were related to ischemic territory. During the maximum stress stage, there was a higher systolic (130.26 ± 19.17 mmHg vs 136.58 ± 27.27 mmHg, 95% CI: -12.77 to 0.14 mmHg, P = 0.055) and diastolic blood pressure (77.89 ± 13.49 mmHg vs 83.95 ± 15.73 mmHg, 95% CI: -10.41 to -1.69 mmHg, P = 0.008) than at the baseline stage, and the same was registered with heart rate (73 ± 10.96 beats/min vs 79.79 ± 11.72 beats/min, 95% CI: -9.46 to -4.11 beats/min, P < 0.01). Nevertheless, there were only 2 hypertensive reactions during the last stage, which did not force a premature end to the test, without sustained tachy or bradyarrhythmias, and the technique was well tolerated in 58% of cases. A unique complication (2.5%) of this test was a prolonged vasospasm with a slight increase in necrosis biomarkers, however, this was without repercussion.CONCLUSION: Ergonovine stress echocardiography can be performed with safety, is well tolerated in the majority of cases, and is useful for determining the ischemia mechanism in selected cases.     

麦角新碱预处理对减轻大鼠移植肝缺血再灌注损伤的作用

目的 探讨使用外源性药物麦角新碱预处理对减轻大鼠移植肝缺血再灌注损伤的作用.方法 在大鼠的门静脉-左肾静脉搭桥、肝后下腔静脉内置管分流法自体原位肝移植模型中,于肝门阻断前10 min经大鼠尾静脉注射麦角新碱;观察移植肝缺血前和再灌注后5 min、30 min、2 h时血清一氧化氮(NO)和血浆内皮素1(ET1)水平以及NO/ET1的比值变化;测定血清丙氨酸转氨酶(ALT)酶学差异和肝组织内三磷酸腺苷(ATP)和丙二醛(MDA)含量变化;再灌注2 h取肝组织检测肝细胞、肝小叶超微结构.结果 应用麦角新碱预处理的大鼠移植肝缺血前门脉血浆中ET1升高(P＜0.01),但再灌注后5 min、30 min时,血浆中ET1水平降低(P＜0.05);而缺血前NO/ET1比值降低(P＜0.01),再灌注后5 min时,NO/ET1比值升高(P＜0.01);再灌注后ALT的升高有逐渐降低趋势;再灌注后2 h肝细胞内超微结构的损害程度减轻.结论 使用麦角新碱预处理能减轻大鼠移植肝缺血再灌注损伤.移植肝缺血再灌注损伤的靶细胞是肝血窦内皮细胞,NO/ET1比值平衡可能是影响移植肝微循环血流量变化的调节因素.     

Mort subite et angor spastique : quelle stratégie diagnostique et thérapeutique ?

The prevalence of vasospastic angina is said to be low in Europe, but maybe because of a lack of diagnosis in the daily practice. However, coronary spasm is a common cause of cardiac arrest, especially among patients free of cardiac illness, and it should be systematically investigated after an unexplained cardiac arrest. Intracoronary spasm provocation test exposes patients to a lower risk compared to the risk of spontaneous spastic angina. Accurate modalities and diagnostic criteria have to be clarified for European population. Avoiding external causes of coronary spasm (such as cigarette smoking or more generally consuming coronary spasm inducing drugs) and prescribing antispastic medicine (first of all calcium channel blockers) are the basis of vasospastic angina treatment. However, recurrent coronary spasms have been reported despite an appropriate treatment and implantable automatic defibrillator has been implanted after case discussion when the onset of illness was cardiac arrest. We report the case of a patient recovering from cardiac arrest who had a positive spasm coronary provocation test, and was treated with calcium channel blockers and had been an automatic defibrillator implanted, with a coronary spasm provocation test performed afterward still contentious. While discussing this case, we are making a literature review of the diagnosis and treatment of spastic angina revealed by cardiac arrest.     

马来酸麦角新碱在经腹腔镜子宫肌瘤剥除术中的临床应用研究

目的 探讨马来酸麦角新碱在子宫肌瘤剔除术中的应用价值。方法 将2018年8月-2018年11月新疆医科大学附属肿瘤医院接诊的55例患者纳入研究,按照随机数字表法均分为观察组30例和对照组25例。对照组经腹腔镜子宫肌瘤剥除术+缩宫素联合治疗。观察组经腹腔镜子宫肌瘤剥除术+马来酸麦角新碱联合治疗。观察2组术中出血量、手术时间、住院时间、手术前后的血红蛋白下降情况、并发症。结果 观察组术中出血量、手术时间、住院时间、手术前后的血红蛋白下降情况均显著低于对照组（P<0.05）,观察组并发症发生率显著低于对照组（P<0.05）。结论 马来酸麦角新碱在子宫肌瘤剔除术中应用效果较好,可以改善患者术中出血量、降低手术前后的血红蛋白下降情况、缩短手术时间、住院时间,降低并发症发生率。