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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
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Persistent chest pain and no obstructive coronary artery disease
Anita Phan1, Chrisandra Shufelt, C Noel Bairey Merz
1Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
JAMA
|April 9, 2009
Summary
Persistent chest pain with normal coronary arteries may stem from microvascular dysfunction or abnormal cardiac nociception. Coronary reactivity testing can diagnose these conditions, improving patient outcomes and reducing healthcare costs.
Area of Science:
- Cardiology
- Diagnostic Medicine
Background:
- Persistent chest pain in patients without obstructive coronary artery disease (CAD) often leads to misdiagnosis as noncardiac pain.
- This diagnostic uncertainty negatively impacts quality of life, increases morbidity, and elevates healthcare expenditures.
Observation:
- Two frequently underdiagnosed cardiac etiologies for persistent chest pain are microvascular coronary dysfunction and abnormal cardiac nociception.
- Microvascular dysfunction involves impaired coronary blood flow regulation and is linked to heightened cardiovascular event risk.
- Abnormal cardiac nociception refers to heightened pain perception originating from the heart.
Findings:
- Coronary reactivity testing enables direct assessment of coronary blood flow in response to vasoactive agents.
- This invasive diagnostic method is crucial for identifying microvascular coronary dysfunction.
- Evidence suggests the risks of coronary reactivity testing are low relative to the prognosis of untreated microvascular dysfunction.
Implications:
- Accurate diagnosis of chest pain in patients with non-obstructive CAD is critical due to associated morbidity and mortality.
- Coronary reactivity testing offers a valuable tool to differentiate cardiac from non-cardiac causes of chest pain.
- Timely diagnosis and targeted treatment for microvascular dysfunction can improve patient outcomes and reduce healthcare burdens.
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