Ergonovine stress echocardiography: Recent experience and safety in our centre

Abstract

AIM:To study recent experience and safety of ergonovine stress echocardiography in our centre. METHODS:In this study we collected the clinical variables of patients referred since 2002 for ergonovine stress echocardiography, in addition to indications, the results of this test, complications, blood pressure and heart rate values during the test and the number and results of tests requested before this technique. RESULTS:We performed 40 tests in 38 patients, 2 tests were carried out to verify therapy efficacy. The prevalence of classic cardiovascular risk factors was low and the most frequent indication was chest pain (57.5%). Coronary angiography was performed in 32 patients, and showed normal coronary arteries in 27 patients and non-significant stenosis in 5 cases. In 16 patients, coronary angiography was carried out after a positive or inconclusive ischemia test. Another 6 patients had a normal stress test (5 exercise electrocardiography tests and 1 nuclear imaging test). Of the 40 ergonovine stress echocardiography tests, 6 were positive (4 in the right coronary artery territory and 2 in the circumflex coronary artery territory), all of them by echocardiographic criteria, and by electrocardiographic criteria in only 3 (50%). The presence of non-significant coronary artery stenosis was more frequent in patients with positive ergonovine stress echocardiography (50% vs 6%, P = 0.038), and were related to ischemic territory. During the maximum stress stage, there was a higher systolic (130.26 ± 19.17 mmHg vs 136.58 ± 27.27 mmHg, 95% CI: -12.77 to 0.14 mmHg, P = 0.055) and diastolic blood pressure (77.89 ± 13.49 mmHg vs 83.95 ± 15.73 mmHg, 95% CI: -10.41 to -1.69 mmHg, P = 0.008) than at the baseline stage, and the same was registered with heart rate (73 ± 10.96 beats/min vs 79.79 ± 11.72 beats/min, 95% CI: -9.46 to -4.11 beats/min, P < 0.01). Nevertheless, there were only 2 hypertensive reactions during the last stage, which did not force a premature end to the test, without sustained tachy or bradyarrhythmias, and the technique was well tolerated in 58% of cases. A unique complication (2.5%) of this test was a prolonged vasospasm with a slight increase in necrosis biomarkers, however, this was without repercussion. CONCLUSION:Ergonovine stress echocardiography can be performed with safety, is well tolerated in the majority of cases, and is useful for determining the ischemia mechanism in selected cases.

Ergonovine Stress Echocardiography for the Diagnosis of Vasospastic Angina and Its Prognostic Implications in 3,094 Consecutive Patients

“…The overall incidence of symptomatic complications in this study was 0.6% (19/3,094), which is lower than those reported in previous reports. 3) 6) In addition, 63% of the complications (12/19) were associated with positive ErgECHO results. Song et al 6) observed complications in 1.9% (26/1,372) of their patients, but they did not document the number of symptomatic patients in their study and 20 out of 26 events were not associated with any positive test response.…”

“…Among the 3,094 tests completed, 265 (8.6%) showed positive results, which was a lower rate than those indicated in previous reports. 3) 6) 18) The low positive ErgECHO result rate may be due to over-testing. Nevertheless, ErgECHO showed a similar positive rate as the ergonovine-provoked CAG for those patients with clinical suspicion of VSA.…”

“…Ergonovine stress echocardiography (ErgECHO) has been shown to be a reliable tool for the diagnosis of vasospasm with high diagnostic accuracy. 3) 4) 5) 6) However, the safety of performing ErgECHO continues to be questioned given the perceived risk of performing ergonovine provocation without the ability to reverse induced spasm with intracoronary nitroglycerin (NTG) and the limited safety data in large populations. 7) Moreover, data supporting its prognostic value are limited.…”

Transient sick sinus syndrome with complete atrioventricular block associated with ergonovine intake

“…Ergonovine currently is believed to be a useful agent that provokes coronary spasm as seen in stress ECG or angiography. [ 3 , 7 ] The half-life of oral ergonovine is 120 minutes. There was a 25% incidence of serious ventricular arrhythmias in 95 patients receiving ergonovine for the diagnosis of variant angina.…”

“…[ 2 ] It was also approved for use in diagnostic testing for Prinzmetal angina or vasospastic angina. [ 3 – 6 ] We present the case of a patient with transient sick sinus syndrome and complete atrioventricular (AV) block with junctional escape rhythm after ergonovine use. This case report was approved by the institutional review board of Chang Gung Medical Foundation.…”