Abstract 18397: Left Ventricular End Diastolic Pressure as a Tool to Detect Intracoronary Ergonovine-Induced Myocardial Ischemia During Provocation Test

Abstract

A drug-induced coronary spasm provocation test is regarded as the gold standard for detection of variant angina. However, a suitable method to detect myocardial ischemia during provocation test is still lacking. We evaluated the feasibility of left ventricular end diastolic pressure (LVEDP) as a tool to detect myocardial ischemia caused by intracoronary (IC) bolus injection of ergonovine. Twenty-nine patients having chest pain without any significant (> 80%) coronary stenosis underwent IC ergonovine provocation test. Epicardial artery spasm of more than 90% was considered as positive. LVEDP was monitored during the entire procedure using a pig-tail catheter. Of the overall 29 patients, ischemic symptom occurred in 16 (55%) and provocation positive was confirmed in 6 (21%). The amount of LVEDP change (ΔLVEDP) was significantly larger in symptomatic group (5.6±4.2 vs. 1.2±2.0 mmHg, p=0.002). The optimal cut-off value of ΔLVEDP for symptom was 4.4 (area under the curve 0.803, sensitivity 69%, specificity 92%) (Figure 1). Of the 6 patients of positive test, five occurred in RCA, one in LAD. Two patients with big patent LCX were not associated with LVEDP elevation more than 4.4 despite significant RCA spasm (Figure 2). Except for the 2, LVEDP elevated significantly in positive test group (7.9±2.9 mmHg, p <0.001, n=4). Elevation of blood pressure and heart rate by IC ergonovine did not correlate with ΔLVEDP (p=0.142 and 0.154, respectively). In conclusion, ΔLVEDP is a specific marker for myocardial ischemia independent of hemodynamic parameters. LVEDP may aid detection of myocardial ischemia which is not associated with significant epicardial spasm during provocation test.