BACKGROUND: The exercise electrocardiogram (ECG) is a standard examination in patients with suspected coronary artery disease. However, despite a pathologic result, many patients undergoing diagnostic coronary angiography do not have any significant epicardial stenosis. In this study, we assessed the relation between a pathologic exercise ECG and coronary microvascular dysfunction in response to intracoronary acetylcholine (ACh) provocation in patients without any relevant epicardial stenosis. HYPOTHESIS: Coronary microvascular dysfunction is significantly more often in patients with angina, unobstructed coronary arteries and a pathologic exercise stress test compared to those without pathologic stress test. METHODS: This study recruited 137 consecutive patients with exertional angina pectoris who underwent diagnostic coronary angiography between September 2008 and April 2011 (68% women; mean age, 63 ± 10 years). In none of the patients was there a stenosis of >50%. All patients underwent an exercise ECG before angiography and intracoronary ACh provocation testing for assessment of coronary vasomotor responses directly after angiography. RESULTS: The exercise ECG showed an abnormal result in 69 patients (50%; ST-segment depression ≥0.1 mV and/or reproduction of the patient's usual symptoms). The ACh test revealed a coronary vasomotor abnormality (reproduction of the patient's symptoms, ischemic ECG shifts ± diffuse distal vasoconstriction) in 87 patients (64%). Such a result was significantly more often found in patients with a pathologic exercise ECG (50/69 [72%] vs 19/69 [28%], P = 0.034). There were no other statistically significant differences between patients with and those without pathologic exercise ECG. CONCLUSIONS: Coronary microvascular dysfunction is frequently found in patients with exertional angina pectoris and unobstructed coronary arteries. Such a finding is found significantly more often in presence of a pathologic exercise ECG.
BACKGROUND: The exercise electrocardiogram (ECG) is a standard examination in patients with suspected coronary artery disease. However, despite a pathologic result, many patients undergoing diagnostic coronary angiography do not have any significant epicardial stenosis. In this study, we assessed the relation between a pathologic exercise ECG and coronary microvascular dysfunction in response to intracoronary acetylcholine (ACh) provocation in patients without any relevant epicardial stenosis. HYPOTHESIS: Coronary microvascular dysfunction is significantly more often in patients with angina, unobstructed coronary arteries and a pathologic exercise stress test compared to those without pathologic stress test. METHODS: This study recruited 137 consecutive patients with exertional angina pectoris who underwent diagnostic coronary angiography between September 2008 and April 2011 (68% women; mean age, 63 ± 10 years). In none of the patients was there a stenosis of >50%. All patients underwent an exercise ECG before angiography and intracoronary ACh provocation testing for assessment of coronary vasomotor responses directly after angiography. RESULTS: The exercise ECG showed an abnormal result in 69 patients (50%; ST-segment depression ≥0.1 mV and/or reproduction of the patient's usual symptoms). The ACh test revealed a coronary vasomotor abnormality (reproduction of the patient's symptoms, ischemic ECG shifts ± diffuse distal vasoconstriction) in 87 patients (64%). Such a result was significantly more often found in patients with a pathologic exercise ECG (50/69 [72%] vs 19/69 [28%], P = 0.034). There were no other statistically significant differences between patients with and those without pathologic exercise ECG. CONCLUSIONS:Coronary microvascular dysfunction is frequently found in patients with exertional angina pectoris and unobstructed coronary arteries. Such a finding is found significantly more often in presence of a pathologic exercise ECG.
Authors: Diana M Lopez; Sanjay Divakaran; Ankur Gupta; Navkaranbir S Bajaj; Michael T Osborne; Wunan Zhou; Jon Hainer; Courtney F Bibbo; Hicham Skali; Sharmila Dorbala; Viviany R Taqueti; Ron Blankstein; Marcelo F Di Carli Journal: JACC Cardiovasc Imaging Date: 2021-08-18
Authors: Harmony R Reynolds; Michael H Picard; John A Spertus; Jesus Peteiro; Jose Luis Lopez Sendon; Roxy Senior; Mohammad C El-Hajjar; Jelena Celutkiene; Michael D Shapiro; Patricia A Pellikka; Dennis F Kunichoff; Rebecca Anthopolos; Khaled Alfakih; Khaled Abdul-Nour; Michel Khouri; Leonid Bershtein; Mark De Belder; Kian Keong Poh; John F Beltrame; James K Min; Jerome L Fleg; Yi Li; David J Maron; Judith S Hochman Journal: Circulation Date: 2021-06-01 Impact factor: 39.918
Authors: Massimo Nardone; Mary McCarthy; Chris I Ardern; Heather Edgell; Olga Toleva; Lynne E Nield; Steven E S Miner Journal: CJC Open Date: 2020-09-25
Authors: Brian Zenger; Wilson W Good; Jake A Bergquist; Lindsay C Rupp; Maura Perez; Gregory J Stoddard; Vikas Sharma; Rob S MacLeod Journal: J Electrocardiol Date: 2021-07-24 Impact factor: 1.380