LAUSR

We thank Dr. Ohyama and colleagues for their interest in our study We agree with Dr. Ohyama's suggestion that we need to clarify the [1], which demonstrated that increased epicardial fat volume (EFV)was associatedwith ergonovine-induced coronary spasms. Dr. Ohyama et al. have recently reported on how increased EFV impacted acetylcholineinduced coronary spasms [2]. They measured both the total EFV and the segmental EFV, according to coronary vessels (perivascular adipose tissue volume: PVATV). They showed that PVATVwas significantly larger in patients with spasms than in controls. As mentioned in the letter by Dr. Ohyama, our finding that EFV was larger in patients with spasms might have reflected an increased segmental PVATV around a vessel spasm. When one measures the segmental volume of peri-coronary adipose tissue, rather than the total volume, the difference in vessel length and/or vascular bed volume should be taken into account. Although the PVATV might be a more reliable index than the total EFV, manually measuring the PVATV index is relatively complicated and time-consuming in daily clinical practice; thus, we anticipate the development of a software program that can automatically calculate the PVATV.