Abnormal diffuse coronary vasomotion

Although coronary artery spasm and abnormal vasoconstriction have undergone considerable investigation, it remains difficult to assess coronary vasomotor tone. To address this problem, the combination of two pharmacological tests (IV injection of 0.4 mg ergometrine followed 5 min later by IV injection of 3 mg isosorbide dinitrate) was performed after the routine procedure of coronary arteriography. Two indexes were defined: total coronary vasomotion (TCV) and maximal total coronary vasomotion (max TCV). These indexes were measured in 20 normal subjects and the normal values were 28.2 +/- 14% and 50.8 +/- 19.2% respectively. Among the 2758 patients who underwent the two tests, a group of 40 patients with normal coronary arteries, no focal spasm and diffuse abnormal coronary vasomotion (DAV) was identified. Eleven patients had vasoconstriction and vasodilatation within the normal range and were identified only by the combination of the 2 tests. All the 40 patients complained of angina at rest and three had had a previous myocardial infarction in the area supplied by the vessel with DAV. During a spontaneous episode of pain at rest 7 patients had ST segment elevation, and 7 a T wave inversion. Thus, these indexes of total coronary vasomotion could be useful to identify patients with abnormal vasomotor tone which could not be detected by the conventional provocative tests.