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SUMMARYA new combined test, accelerated exercise following mild hyperventilation (HV), was examined to determine whether it is effective at detecting a positive response in patients with pharmacologically-induced coronary vasospasm and near normal coronary arteries.Fifty-eight consecutive patients who underwent both triple non-invasive spasm provocation tests and diagnostic coronary angiography were enrolled. They all had pharmacologically-induced coronary vasospasms and no significant organic stenosis. In these patients, an HV test was performed first, followed by a treadmill exercise test (TET), and finally the new combined test under no medication within 3 days. Of the 58 patients, positive responses were observed in 9 patients to the HV, in 15 to the TET, and in 35 to the newly combined test. The remaining 21 patients had negative responses although the triple sequential tests were perfomed. Thus, the sensitivities of the HV test, TET, and newly combined test were 16% (9/58), 26% (15/58), and 63% (35/56), respectively. Forty-six subjects with near normal coronary arteries and no ACh-provoked spasm served as controls. None of these subjects had positive responses to any of these three tests, and thus their specificity was all 100%. No serious or irreversible complications were seen in this study.We recommend this newly-combined protocol for the induction of coronary artery spasm in patients with vasospastic angina pectoris and without significant stenosis as a diagnostic tool. (Jpn Heart J 2002; 43: 307-317) Key words: Coronary spastic angina, Exercise test, Hyperventilation HYPERVENTILATION (HV), cold stress, and exercise tests have been clinically performed as non-invasive provocation tests for coronary vasospasm, [1][2][3][4][5] whereas invasive provocation tests, such as intracoronary injection of acetylcholine (ACh) or ergonovine (ER) are performed to diagnose patients with coronary spastic angina in the cardiac laboratory.6-11) However, due to circadian variaFrom the