Characterization and implications of intracoronary hemodynamic assessment during coronary spasm provocation testing.
ANOCA
Coronary spasm
Microvascular dysfunction
Vasomotor disorder
Vasospastic angina
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
22
03
2023
accepted:
02
05
2023
medline:
25
8
2023
pubmed:
17
5
2023
entrez:
17
5
2023
Statut:
ppublish
Résumé
Current diagnostic criteria for coronary spasm are based on patient's symptoms, ECG shifts and epicardial vasoconstriction during acetylcholine (ACh) spasm testing. To assess the feasibility and diagnostic value of coronary blood flow (CBF) and resistance (CR) assessment as objective parameters during ACh testing. Eighty-nine patients who underwent intracoronary reactivity testing including ACh testing with synchronous Doppler wire-based measurements of CBF and CR were included. Coronary microvascular and epicardial spasm, respectively, were diagnosed based on COVADIS criteria. Patients were 63 ± 13 years old, predominantly female (69%) and had preserved LV ejection fraction (64 ± 8%). Overall, assessment of CBF and CR during ACh testing revealed a decrease in CBF of 0.62 (0.17-1.53)-fold and an increase of CR of 1.45 [0.67-4.02]-fold in spasm patients compared to 2.08 (1.73-4.76) for CBF and 0.45 (0.44-0.63) for CR in patients without coronary spasm (both p < 0.01). Receiver operating characteristic revealed a high diagnostic ability of CBF and CR (AUC 0.86, p < 0.001, respectively) in identifying patients with coronary spasm. However, in 21% of patients with epicardial spasm and 42% of patients with microvascular spasm a paradoxical response was observed. This study demonstrates feasibility and potential diagnostic value of intracoronary physiology assessments during ACh testing. We observed opposite responses of CBF and CR to ACh in patients with positive vs. negative spasm test. While a decrease in CBF and an increase in CR during ACh seem pathognomonic for spasm, some patients with coronary spasm demonstrate paradoxical ACh response demanding further scientific investigations.
Sections du résumé
BACKGROUND
BACKGROUND
Current diagnostic criteria for coronary spasm are based on patient's symptoms, ECG shifts and epicardial vasoconstriction during acetylcholine (ACh) spasm testing.
AIMS
OBJECTIVE
To assess the feasibility and diagnostic value of coronary blood flow (CBF) and resistance (CR) assessment as objective parameters during ACh testing.
METHODS
METHODS
Eighty-nine patients who underwent intracoronary reactivity testing including ACh testing with synchronous Doppler wire-based measurements of CBF and CR were included. Coronary microvascular and epicardial spasm, respectively, were diagnosed based on COVADIS criteria.
RESULTS
RESULTS
Patients were 63 ± 13 years old, predominantly female (69%) and had preserved LV ejection fraction (64 ± 8%). Overall, assessment of CBF and CR during ACh testing revealed a decrease in CBF of 0.62 (0.17-1.53)-fold and an increase of CR of 1.45 [0.67-4.02]-fold in spasm patients compared to 2.08 (1.73-4.76) for CBF and 0.45 (0.44-0.63) for CR in patients without coronary spasm (both p < 0.01). Receiver operating characteristic revealed a high diagnostic ability of CBF and CR (AUC 0.86, p < 0.001, respectively) in identifying patients with coronary spasm. However, in 21% of patients with epicardial spasm and 42% of patients with microvascular spasm a paradoxical response was observed.
CONCLUSIONS
CONCLUSIONS
This study demonstrates feasibility and potential diagnostic value of intracoronary physiology assessments during ACh testing. We observed opposite responses of CBF and CR to ACh in patients with positive vs. negative spasm test. While a decrease in CBF and an increase in CR during ACh seem pathognomonic for spasm, some patients with coronary spasm demonstrate paradoxical ACh response demanding further scientific investigations.
Identifiants
pubmed: 37195455
doi: 10.1007/s00392-023-02224-1
pii: 10.1007/s00392-023-02224-1
doi:
Substances chimiques
Acetylcholine
N9YNS0M02X
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1312-1321Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Suda A, Takahashi J, Hao K et al (2019) Coronary functional abnormalities in patients with angina and nonobstructive coronary artery disease. J Am Coll Cardiol 74(19):2350–2360
doi: 10.1016/j.jacc.2019.08.1056
pubmed: 31699275
Konst RE, Damman P, Pellegrini D et al (2021) Vasomotor dysfunction in patients with angina and nonobstructive coronary artery disease is dominated by vasospasm. Int J Cardiol 333:14–20
doi: 10.1016/j.ijcard.2021.02.079
pubmed: 33711394
Ford TJ, Yii E, Sidik N et al (2019) Ischemia and no obstructive coronary artery disease: prevalence and correlates of coronary vasomotion disorders. Circ Cardiovasc Interv 12(12):e008126
doi: 10.1161/CIRCINTERVENTIONS.119.008126
pubmed: 31833416
pmcid: 6924940
Ong P, Camici PG, Beltrame JF et al (2018) International standardization of diagnostic criteria for microvascular angina. Int J Cardiol 250:16–20
doi: 10.1016/j.ijcard.2017.08.068
pubmed: 29031990
MacAlpin RN, Weidner WA, Kattus AA Jr et al (1966) Electrocardiographic changes during selective coronary cineangiography. Circulation 34(4):627–637
doi: 10.1161/01.CIR.34.4.627
pubmed: 5921758
Takahashi J, Suda A, Yasuda S et al (2021) Measurement of myocardial lactate production for diagnosis of coronary microvascular spasm. J Vis Exp. https://doi.org/10.3791/62558
doi: 10.3791/62558
pubmed: 34605803
Sun H, Fukumoto Y, Ito A et al (2005) Coronary microvascular dysfunction in patients with microvascular angina: analysis by TIMI frame count. J Cardiovasc Pharmacol 46(5):622–626
doi: 10.1097/01.fjc.0000181291.96086.ae
pubmed: 16220069
Chugh SK, Koppel J, Scott M et al (2004) Coronary flow velocity reserve does not correlate with TIMI frame count in patients undergoing non-emergency percutaneous coronary intervention. J Am Coll Cardiol 44(4):778–782
doi: 10.1016/j.jacc.2004.05.048
pubmed: 15312858
Guenther F, Seitz A, Pereyra VM et al (2020) Does coronary microvascular spasm exist? Objective evidence from intracoronary doppler flow measurements during acetylcholine testing. Cardiovasc Innov Appl 4(3):205–209
Seitz A, Beck S, Pereyra VM et al (2021) Testing acetylcholine followed by adenosine for invasive diagnosis of coronary vasomotor disorders. J Vis Exp. https://doi.org/10.3791/62134
doi: 10.3791/62134
pubmed: 33616102
Beltrame JF, Crea F, Kaski JC et al (2017) International standardization of diagnostic criteria for vasospastic angina. Eur Heart J 38(33):2565–2568
pubmed: 26245334
Ong P, Camici PG, Beltrame JF et al (2017) International standardization of diagnostic criteria for microvascular angina. Int J Cardiol 250:16–20
doi: 10.1016/j.ijcard.2017.08.068
pubmed: 29031990
Doucette JW, Corl PD, Payne HM et al (1992) Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 85(5):1899–1911
doi: 10.1161/01.CIR.85.5.1899
pubmed: 1572046
Meuwissen M, Chamuleau SA, Siebes M et al (2001) Role of variability in microvascular resistance on fractional flow reserve and coronary blood flow velocity reserve in intermediate coronary lesions. Circulation 103(2):184–187
doi: 10.1161/01.CIR.103.2.184
pubmed: 11208673
Langenberg CJ, Pietersen HG, Geskes G et al (2003) Coronary sinus catheter placement: assessment of placement criteria and cardiac complications. Chest 124(4):1259–1265
doi: 10.1378/chest.124.4.1259
pubmed: 14555554
Gallinoro E, Paolisso P, Bermpeis K et al (2022) When “Slow Flow” Is Not “Low Flow.” JACC Cardiovasc Interv 15:e119–e121
doi: 10.1016/j.jcin.2022.02.015
pubmed: 35490131
Ohba K, Sugiyama S, Sumida H et al (2012) Microvascular coronary artery spasm presents distinctive clinical features with endothelial dysfunction as nonobstructive coronary artery disease. J Am Heart Assoc 1(5):e002485
doi: 10.1161/JAHA.112.002485
pubmed: 23316292
pmcid: 3541613
Mohri M, Koyanagi M, Egashira K et al (1998) Angina pectoris caused by coronary microvascular spasm. Lancet 351(9110):1165–1169
doi: 10.1016/S0140-6736(97)07329-7
pubmed: 9643687
Feenstra RGT, Seitz A, Boerhout CKM et al (2022) Principles and pitfalls in coronary vasomotor function testing. EuroIntervention 17(15):1271–1280
doi: 10.4244/EIJ-D-21-00402
pubmed: 34278990
pmcid: 9725006