[Vasospastic angina: An under-diagnosed pathology]

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Spastic angina (variant angina) is a recognized but under-diagnosed cardiac condition.
• It is associated with serious complications, including fatal arrhythmias like ventricular fibrillation.
• The condition is more prevalent and better documented in Japan compared to France.

Purpose of the Study:

• To highlight the under-diagnosis and under-estimation of spastic angina.
• To emphasize the need for improved detection strategies for spastic angina.
• To advocate for the increased use and sensitivity of diagnostic provocation tests.

Main Methods:

• Review of clinical and physiopathological documentation of spastic angina.
• Comparison of diagnostic approaches and outcomes between Japan and France.
• Recommendation for ergonovine provocation tests for diagnosis.
• Suggestion for intracoronary administration of ergonovine to enhance test sensitivity and safety.

Main Results:

• Spastic angina is frequently under-diagnosed, leading to missed treatment opportunities.
• Ergonovine provocation tests are crucial for diagnosis, with higher positivity rates in regions with more frequent testing.
• Intracoronary ergonovine may improve test sensitivity while minimizing complications.

Conclusions:

• Improved detection of spastic angina is crucial, particularly in patients with nocturnal rest angina or sudden cardiac death without obstructive coronary artery disease.
• Ergonovine provocation tests, especially via the intracoronary route, are key diagnostic tools.
• Timely diagnosis and therapeutic management can significantly improve outcomes for patients with spastic angina.