Efficiency of ergonovine echocardiography in detecting angiographically assessed coronary vasospasm

Abstract

Coronary vasospasm plays a major role in provoking myocardial ischemia in patients with variant angina, but also in some patients with acute coronary syndrome including unstable angina, myocardial infarction, and sudden death. Ergonovine provocation has been used for >20 years for detection of coronary artery spasm. 1 Maseri A. L.’Abbate A. Pesola A. Ballestra A. Marzilli M. Maltinti G. Severi S. De Ness D.M. Parodi O. Biagini A. Coronary vasospasm in angina pectoris. Lancet. 1977; 1: 713-717 Abstract PubMed Scopus (153) Google Scholar , 2 Schroeder J.S. Bolen J.L. Wuint R.A. Clark D.A. Hayden W.G. Higgins C.B. Wexler L. Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography. Am J Cardiol. 1977; 40: 487-491 Abstract Full Text PDF PubMed Scopus (226) Google Scholar , 3 Heupler F.A. Proudfit W.L. Razavi M. Shirey E.K. Greenstreet R. Sheldon W.C. Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol. 1978; 41: 631-640 Abstract Full Text PDF PubMed Scopus (270) Google Scholar Most data on ergonovine testing have been reported in the preselected group of patients with variant angina, establishing ergonovine as a test of high diagnostic confidence. 4 Bott-Silverman C. Heupler F.A. Yiannikis J. Variant angina comparison of patients with and without fixed severe coronary artery disease. Am J Cardiol. 1984; 54: 1173-1175 Abstract Full Text PDF PubMed Scopus (19) Google Scholar , 5 Bory M. Pierron F. Panagides J. Bonnet J.L. Yvorra S. Desfossez L. Coronary artery spasm in patients with normal or near-normal coronary arteries. Long-term follow-up of 277 patients. Eur Heart J. 1996; 17: 1015-1021 Crossref PubMed Scopus (157) Google Scholar In current clinical practice, when a marked decline in the use of ergonovine testing in the catheterization laboratory is observed, 6 Song J.K. Park S.W. Kang D.H. Hong M.K. Kim J.J. Lee C.W. Park S.J. Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm. J Am Coll Cardiol. 2000; 35: 1850-1856 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar accompanied by promising reports on ergonovine echocardiography, a question remains on the incidence, safety, and usefulness of provocative testing for coronary vasospasm in patients with chest pain syndrome and nonsignificant coronary artery stenosis. Thus, the objectives of our study were to evaluate (1) the incidence of angiographically assessed coronary vasospasm in a consecutive population of patients with nonsignificant coronary artery disease, (2) the efficiency of simultaneously performed ergonovine echocardiography in identifying coronary vasospasm, and (3) the relation between ergonovine echocardiographic and angiographic results.