Vasospasm in acute coronary syndrome: does ergonovine stress echocardiogram have a role?

Kim, Moo H; Park, Tae H.; Yang, Doo Kyung; Oh, Wook; Kwang, S; Kim, Young D.; Kim, Jong Seung

doi:10.1016/s0735-1097(02)81669-2

Cited by 9 publications

(13 citation statements)

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“…Consistent with the literature, an important number of positive cases did not have electrocardiographic changes; this finding does not support the performance of techniques with only electrocardiographic monitoring [12,13,22] . Among the patients with positive tests, 5 (83%) developed chest pain, while only 1 patient with a negative test had chest pain with the highest ergonovine dose, but without worsening of myocardial wall motion or significant electrocardiographic changes.…”

Section: Discussionsupporting

confidence: 48%

“…Vasospasm may be related to a hypersensitivity to vasoconstrictor stimulus, with an imbalance between relaxing factors, such as nitric oxide, and constrictor factors released by the endothelium. Oxidative stress, endothelial dysfunction, high endothelin-1 activity and regional sympathetic denervation demonstrated by nuclear imaging may play an important part in the pathogenesis of coronary vasospasm [12,13,[19][20][21] . Test positivity would support the diagnosis of coronary vasospasm, contributing to a complete differential diagnosis of chest pain, while if the test is normal, suspicion of vasospasm has to be based on treatment response and clinical picture.…”

Section: Discussionmentioning

confidence: 99%

“…One problem with this test may be the lack of a central venous approach for temporary pacing or an intracoronary catheter for intracoronary medicine infusion. However, with regard to its safety, several studies have reported a very low rate of complications, similar to dobutamine or dipyridamole, when appropriate patient selection is carried out by excluding those with significant stenosis and rapidly administering the antidote [9][10][11][12][13] . The most frequently affected territory is normally the one related to the left anterior descending coronary artery, followed by the right coronary artery [9,10] .…”

Section: Discussionmentioning

confidence: 99%

“…Chest pain is not a variable systematically registered in other studies because it is not a criterion for a positive response [3,12,14,15,20,22] . In one study in which 52 patients with acute coronary syndrome and normal or near-normal coronary angiograms were enrolled [13] , chest pain was registered in 19 cases (76%) with positive ergonovine stress echocardiography and in 4 patients (15%) in the group with a negative test. These data were similar to the data found in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are a number of studies which have demonstrated that ergonovine stress echocardiography is a safe tool for the diagnosis of vasospasm, after confirming the absence of inducible ischemia or significant coronary stenosis by coronary angiography, and has many advantages compared with invasive provocation tests. These techniques have relevancy, especially, in the differential diagnosis of resting chest pain, which is suspected to be related to the vasospastic origin, in which coronary angiography or coronary computed tomography do not show significant stenosis [7][8][9][10][11][12][13][14][15][16][17] . In this study, we assessed the experience related to ergonovine stress echocardiography over the last few years in our centre, collected the clinical variables of patients referred to our laboratory and the test results.…”

Section: Introductionmentioning

confidence: 99%

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Ergonovine stress echocardiography: Recent experience and safety in our centre

Cortell¹

2010

WJC

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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.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ergonovine stress echocardiography: Recent experience and safety in our centre

Cortell¹

2010

WJC

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Resting Chest Pain, Negative Treadmill Exercise Electrocardiogram, and Reverse Redistribution in Dipyridamole Myocardial Perfusion Scintigraphy Might be the Features of Coronary Artery Spasm

Xiang¹,

Yin

et al. 2007

Clinical Cardiology

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SummaryBackground: Coronary artery spasm usually attacks while at rest and the diagnosis depends on provoking tests which mostly are invasive, expensive and not practical. Previous investigations demonstrated that in most patients with coronary artery spasm, treadmill exercise electrocardiography (TEEC) did not induce any ischemic changes, and myocardial perfusion scintigraphy (MPS) showed reverse redistribution (RR).Hypothesis: Combination of resting chest pain, negative TEEC and RR might be a rational noninvasive set to predict coronary artery spasm.Methods: Patients with chest pain at rest, no significant coronary artery stenosis, and willing to undergo acetylcholine test were included. TEEC, dipyridamole and rest thallium-201 MPS were performed before or after coronary angiography. The patients were divided into spasm and nonspasm groups by acetylcholine test. The clinical features and results of TEEC and MPS were compared between the spasm and nonspasm groups.Results: Acetylcholine test was performed in 92 patients and coronary artery spasm was successfully provoked in 68 patients. Positive TEEC was induced in only 4 patients in the spasm group. RR was present in totally 77 patients and 68 of them were from the spasm group. By a combination of resting chest pain, negative TEEC

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Provoked Coronary Spasm and Acute Coronary Syndromes⁎⁎Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.

Pepine

2008

Journal of the American College of Cardiology

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Although coronary artery spasm (CAS) has been linked with acute coronary syndromes (ACS) and vulnerable plaque (1), thrombosis (2), percutaneous coronary intervention (PCI), and stenting (3-7), very limited attention is given to CAS in the current era. This may be related to assumptions that the frequency of CAS is decreasing and if present it will be eliminated with calcium antagonist (8) or nitrate use. However, concerns about adverse outcomes in hypertensive and angina patients over the past decade have diminished calcium antagonist use, particularly in ACS. Long-acting nitrates, once a standard discharge order, are not recommended discharge medications in recent ACS guidelines (9 -11). Important to the perception that CAS is decreasing is the lack of testing to detect spasm as a possible mechanism for ACS when other causes are not apparent. Except for Prinzmetal angina and cocaine use, CAS testing is either not mentioned (9,10) or is given only a IIb recommendation (11) among patients without obstructive coronary artery disease (CAD) in recent guidelines. Therefore, among ACS patients the frequency of CAS was unknown, and it was uncertain whether it was simply a mediator of ischemia among other factors, a marker predicting adverse outcome, or both. See pages 518 and 523This is the setting for 2 provocative reports on coronary spasm in ACS published in this issue of the Journal. Using a prospective cohort design, Wakabayashi et al. (12) tested consecutive Japanese patients for CAS 10 to 20 days after acute myocardial infarction (MI) treated by PCI. Spasm was provoked in about 70% of cases, and almost one-half of these had an event (death, ACS, or revascularization) over follow-up. Spasm was provoked in the majority of arteries examined; occurring in approximately 70% of infarct-related arteries and about one-half of noninfarct-related arteries.Finding CAS in these latter cases indicates that spasm was not related to vascular injury associated with the PCI. Provoked spasm was an independent predictor of adverse outcome, and although exploratory, their analysis suggests that CAS may be linked with early nonobstructive vulnerable plaque as a precursor to recurrent ACS in multiple arteries rather than only the infarct-related lesion. Ong et al. (13) continued this theme of spasm testing in ACS patients without obstructive lesions. Spasm was provoked in approximately 50% of these marker-positive (electrocardiographic [ECG] and/or biochemical) Caucasian cases. Interestingly, smoking history, long recognized as a risk condition for spasm (14), was present in only about one-fourth of these cases and did not differ significantly comparing those with and without spasm. This also held true for other factors previously linked with CAS, such as female gender and hypertension.Although these data, indicating a very high frequency of multivessel CAS in ACS patients possibly linked with adverse outcomes, are very interesting, there are some limitations. The Wakabayashi et al. (12) study conclusions would be stronger if the o...

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Vasospasm in acute coronary syndrome: does ergonovine stress echocardiogram have a role?

Cited by 9 publications

References 0 publications

Ergonovine stress echocardiography: Recent experience and safety in our centre

Ergonovine stress echocardiography: Recent experience and safety in our centre

Resting Chest Pain, Negative Treadmill Exercise Electrocardiogram, and Reverse Redistribution in Dipyridamole Myocardial Perfusion Scintigraphy Might be the Features of Coronary Artery Spasm

Provoked Coronary Spasm and Acute Coronary Syndromes⁎⁎Editorials published in the Journal of the American College of Cardiology reflect the views of the authors and do not necessarily represent the views of JACC or the American College of Cardiology.

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