STUDY OBJECTIVES: This study was performed to compare the results of accelerated exercise following mild hyperventilation and a standard acetylcholine (ACh) test for the induction of coronary artery spasm in patients with drug-induced coronary artery spasm. METHODS AND RESULTS: The subjects were 74 patients with angiographically confirmed coronary artery spasm who were examined using accelerated exercise (ie, exercise that was accelerated every minute according to the protocol of Bruce and Horsten) following mild hyperventilation and who were not receiving any medication. ACh was injected in incremental doses of 20 microg and 50 microg into the right coronary artery and incremental doses of 20 microg, 50 microg, and 100 microg into the left coronary artery. Positive coronary spasm was defined as > or =99% luminal narrowing. Accelerated exercise following a mild hyperventilation test was as useful for detecting evidence of ischemia as was an ACh test (48 patients [64.9%] vs 49 patients [66.2%], respectively; not significant). No difference was observed between ischemic changes on ECG as a result of the newly combined method and the occurrence of ACh-induced spasm. ACh-induced coronary vasospasm occurred in 61 patients (82.4%). In the remaining 13 patients, intracoronary administration of ergonovine provoked coronary spasms. No serious irreversible complications were detected as a result of this newly combined method. CONCLUSIONS: The effectiveness of our newly combined procedure is equivalent to that of an ACh test to diagnose patients with coronary artery spasm.
STUDY OBJECTIVES: This study was performed to compare the results of accelerated exercise following mild hyperventilation and a standard acetylcholine (ACh) test for the induction of coronary artery spasm in patients with drug-induced coronary artery spasm. METHODS AND RESULTS: The subjects were 74 patients with angiographically confirmed coronary artery spasm who were examined using accelerated exercise (ie, exercise that was accelerated every minute according to the protocol of Bruce and Horsten) following mild hyperventilation and who were not receiving any medication. ACh was injected in incremental doses of 20 microg and 50 microg into the right coronary artery and incremental doses of 20 microg, 50 microg, and 100 microg into the left coronary artery. Positive coronary spasm was defined as > or =99% luminal narrowing. Accelerated exercise following a mild hyperventilation test was as useful for detecting evidence of ischemia as was an ACh test (48 patients [64.9%] vs 49 patients [66.2%], respectively; not significant). No difference was observed between ischemic changes on ECG as a result of the newly combined method and the occurrence of ACh-induced spasm. ACh-induced coronary vasospasm occurred in 61 patients (82.4%). In the remaining 13 patients, intracoronary administration of ergonovine provoked coronary spasms. No serious irreversible complications were detected as a result of this newly combined method. CONCLUSIONS: The effectiveness of our newly combined procedure is equivalent to that of an ACh test to diagnose patients with coronary artery spasm.
Authors: Eugenio Picano; Quirino Ciampi; Lauro Cortigiani; Adelaide M Arruda-Olson; Clarissa Borguezan-Daros; José Luis de Castro E Silva Pretto; Rosangela Cocchia; Eduardo Bossone; Elisa Merli; Garvan C Kane; Albert Varga; Gergely Agoston; Maria Chiara Scali; Doralisa Morrone; Iana Simova; Martina Samardjieva; Alla Boshchenko; Tamara Ryabova; Alexander Vrublevsky; Attila Palinkas; Eszter D Palinkas; Robert Sepp; Marco A R Torres; Hector R Villarraga; Tamara Kovačević Preradović; Rodolfo Citro; Miguel Amor; Hugo Mosto; Michael Salamè; Paul Leeson; Cristina Mangia; Nicola Gaibazzi; Domenico Tuttolomondo; Costantina Prota; Jesus Peteiro; Caroline M Van De Heyning; Antonello D'Andrea; Fausto Rigo; Aleksandra Nikolic; Miodrag Ostojic; Jorge Lowenstein; Rosina Arbucci; Diego M Lowenstein Haber; Pablo M Merlo; Karina Wierzbowska-Drabik; Jaroslaw D Kasprzak; Maciej Haberka; Ana Cristina Camarozano; Nithima Ratanasit; Fabio Mori; Maria Grazia D'Alfonso; Luigi Tassetti; Alessandra Milazzo; Iacopo Olivotto; Alberto Marchi; Hugo Rodriguez-Zanella; Angela Zagatina; Ratnasari Padang; Milica Dekleva; Ana Djordievic-Dikic; Nikola Boskovic; Milorad Tesic; Vojislav Giga; Branko Beleslin; Giovanni Di Salvo; Valentina Lorenzoni; Matteo Cameli; Giulia Elena Mandoli; Tonino Bombardini; Pio Caso; Jelena Celutkiene; Andrea Barbieri; Giovanni Benfari; Ylenia Bartolacelli; Alessandro Malagoli; Francesca Bursi; Francesca Mantovani; Bruno Villari; Antonello Russo; Michele De Nes; Clara Carpeggiani; Ines Monte; Federica Re; Carlos Cotrim; Giuseppe Bilardo; Ariel K Saad; Arnas Karuzas; Dovydas Matuliauskas; Paolo Colonna; Francesco Antonini-Canterin; Mauro Pepi; Patricia A Pellikka Journal: J Clin Med Date: 2021-08-17 Impact factor: 4.964