Increased peripheral vasoconstrictor reaction upon local cold in patients with coronary heart disease

A local cold exposure test of the nailfold capillaries produces a typical flow stop reaction in 88% of patients with Raynaud's phenomenon. We applied this test to 12 patients with variant angina and compared the results with the findings in 2 control groups of 12 patients each, matched for age and sex: One group with chronic stable angina and one without heart disease. We found a flow stop with cold exposure in 9/12 patients with variant angina (mean duration 24 s), in 6/12 patients with chronic angina (mean 11 s), and in 1/12 normal controls without heart disease (mean 1 s). The frequency and duration of the flow stop was significantly higher in patients with variant angina (p = 0.002) and in patients with chronic stable angina (p = 0.02) than in normal controls. Patients with variant angina also tended to have an increased frequency and longer duration of the flow stop than those with chronic stable angina (p = 0.09). Administration of sorbidilate preparations and nifedipine resulted in a decrease of the mean flow stop duration from 23.5 to 10.8 s in patients with variant angina (p = 0.03). The strong association of a vasoconstrictive reaction in finger microcirculation and coronaries in patients with variant angina suggests a vasospastic tendency with manifestation in different vascular regions.