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J Am Coll Cardiol, 1999; 33:1442-1452 © 1999 by the American College of Cardiology Foundation |
* Cardiology Unit, The North Western Adelaide Health Service, University of Adelaide, Adelaide, Australia
Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto University Graduate School of Medicine, Kyoto, Japan
Cardiology Institute, Agostino Gemelli Hospital, The Catholic University of the Sacred Heart, Rome, Italy
Manuscript received June 29, 1998; revised manuscript received December 14, 1998, accepted January 21, 1999.
Reprint requests and correspondence: Dr. J.F. Beltrame, Cardiology Unit, The North Western Adelaide Health Service, The Queen Elizabeth Hospital Campus, 28 Woodville Rd, Woodville South, SA 5011, Australia
Japanese investigators have provided a substantial contribution in the understanding of coronary vasomotor reactivity. On occasions, their findings have been at variance with those undertaken on caucasian patients, raising speculation that vasomotor differences between races may exist. In a comparative review of the published literature, we evaluated the vasoreactive differences among Japanese and caucasian patients with variant angina or myocardial infarction. In variant angina, Japanese patients appear to have diffusely hyperreactive coronary arteries compared with caucasian people, manifested by their segmental rather than focal spasm, hyperreactive nonspastic vessels and multivessel spasm. These differences may reflect the increased basal tone among Japanese variant angina patients and may relate to controversial differences in endothelial nitric oxide production or autonomic nervous system activity. Provocative vasomotor studies of Japanese patients with a recent myocardial infarction report a higher incidence of inducible spasm than caucasian studies, an observation recently supported by a controlled study. Furthermore, the hyperreactivity was diffuse, occurring in both non–infarct- and infarct-related vessels. These observations support the existence of racial coronary vasomotor reactivity differences but require confirmation in further prospectively conducted studies.
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