Comprehensive Assessment of Vasospastic Angina using Coronary CT Angiography: Synergistic Value of the Presence of Myocardial Bridge, Perivascular inflammation, and Myocardial Extracellular Volume Fraction

Clicks: 24
ID: 321004
2026
Free PDF
Article Quality & Performance Metrics
Overall Quality
Not rated
Combines reader engagement with the AI quality analysis. This article has not been analysed, so there is no overall score — reader engagement is measured and shown alongside.
AI Quality Assessment
Not analyzed
Readership in this journal
Steady

Ranked #33 of 157 articles by views in European Heart Journal - Cardiovascular Imaging

Most read Least read

Bar heights use a square-root scale. Only the 120 most-read articles are drawn; the journal has 157 in total.

Mint this article as an NFT
Not yet minted

Create a permanent, verifiable on-chain record of this article on the Scimatic Network. The NFT is held in your Journament account, and you can withdraw it to your own wallet at any time.

5 SUSD one-off · no wallet required
Sign in to mint
Abstract
BACKGROUND: Coronary CT angiography (CCTA) has evolved beyond anatomical assessment to include sophisticated tissue characterization. While an elevated perivascular fat attenuation index around the right coronary artery (FAI-RCA) is known to reflect coronary inflammation in vasospastic angina (VSA), recurrent vasospasms may also induce chronic subclinical myocardial injury and subsequent remodeling, potentially associated with an increased myocardial extracellular volume fraction (ECV). However, the diagnostic integration of ECV and FAI-RCA for identifying VSA in patients with angina with non-obstructive coronary arteries (ANOCA) remains to be elucidated. METHODS AND RESULTS: This study included consecutive ANOCA patients underwent CCTA with a dedicated ECV protocol, followed by an invasive spasm provocation test. Comprehensive CCTA analysis quantified both FAI-RCA and the transmural ECV gradient (the difference between endocardial and epicardial ECV: ECVEndo-ECVEpi). Of the 100 patients analyzed (mean age:65.3 ± 11.8 years; 55% male), 27 were diagnosed with VSA. Multivariable logistic regression analysis identified transmural ECV gradient [OR:1.12(95% CI:1.01-1.25)], presence of myocardial bridging (MB) [OR:3.49(1.25-9.74)], and high FAI-RCA (>-70.95HU) [OR:5.79(2.06-16.30)] as significant independent predictors of VSA (all P < 0.05). Notably, the integration of transmural ECV gradient provided incremental diagnostic value beyond FAI-RCA and MB assessed by net reclassification improvement and integrated discrimination improvement. CONCLUSIONS: A multi-parametric CCTA approach potentially identifies patients at high risk for VSA. The significant association of transmural ECV gradient with VSA suggests that myocardial remodeling imaging provides a novel diagnostic window into the cumulative myocardial impact of vasospasm, independent of active adipose tissue inflammation and the presence of MB.
Reference Key
openalex_W7168259315 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Kodai Sayama, Yoshihisa Kanaji, Eisuke Usui, Hiroki Ueno, Tomohiro Tahara, Takahiro Watanabe, Riko Murakami, Takashi Mineo, Shunta Hiroi, Kaisei Hosokawa, Kai Nogami, Masahiro Hada, Masahiro Hoshino, Tomoyo Sugiyama, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta
Are you one of these authors? Claim your profile
Journal European Heart Journal - Cardiovascular Imaging
Year 2026
DOI
10.1093/ehjci/jeag181
URL
https://doi.org/10.1093/ehjci/jeag181
Keywords Keywords not found

Citations

No citations found. To add a citation, contact the admin at info@scimatic.org

Comments

No comments yet. Be the first to comment on this article.