The Association between Coronary Spasm and B-type Natriuretic Peptide and Pulse Wave Velocity

Abstract

Background: Coronary spasm causes transient left ventricular dysfunction and consequently may increase B-type natriuretic peptide (BNP) by chance. However, the correlation between coronary spasm and BNP has not been verified. We investigated the association between coronary spasm and BNP and pulse wave velocity (PWV) in patients with preserved left ventricular function.

Methods: Patients with chest pain who have ejection fraction > 50% underwent both diagnostic coronary angiography with acetylcholine provocation and NT-proBNP measurement simultaneously were enrolled for the study. PWV test was done in all patients. Significant coronary artery spasm was defined as focal (>70%) or diffuse severe transient luminal narrowing (>90%) with or without chest pain or ST-T change of electrocardiogram.

Results: Among total 1,342 patients, 793 patients with heart failure, arrhythmia, coronary artery disease or valvular heart disease were excluded and 549 patients were enrolled. Thirty five percent (192/549) of enrolled subjects showed positive results at acetylcholine provocation test. Baseline characteristics were well balanced between the spasm group and control group. In the univariate analysis, the BNP levels of spasm group were lower than control group (146 ¡¾ 363 pg/mL vs. 197 ¡¾ 532 pg/mL, P=0.050). But in the multivariate analysis, there was no significant difference of BNP between two groups. Also there was no difference of PWV value between the groups.

Conclusion: There is no significant relationship between BNP, PWV and coronary spasm. These finding suggest that coronary spasm with normal left ventricular systolic function is not associated with BNP or PWV.