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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
06:39

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

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Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine

Rutger G T Feenstra1, Coen K M Boerhout1, Caitlin E M Vink1

  • 1Amsterdam UMC, Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.

International Journal of Cardiology. Heart & Vasculature
|August 26, 2022
PubMed

Insights

Acetylcholine testing reveals distinct coronary artery spasm (CAS) endotypes. Low-dose acetylcholine suggests intact endothelium in negative and equivocal groups, while high-dose indicates smooth muscle cell hyperreactivity across multiple CAS endotypes.

Area of Science:

  • Cardiology
  • Vascular Physiology
  • Pharmacology

Background:

  • Acetylcholine (ACh) is used to test coronary vasoreactivity.
  • High-dose ACh assesses vasospasm provocation, while low-dose ACh evaluates endothelial function.

Purpose of the Study:

  • To evaluate changes in response to low- and high-dose ACh in different coronary artery spasm (CAS) endotypes.
  • To differentiate endotypes using the Coronary Vasomotor Disorders International Study Group (COVADIS) classification.

Main Methods:

  • Assessed changes in coronary epicardial diameter, coronary blood flow (CBF), and vascular resistance.
  • Utilized incremental infusion of acetylcholine in 88 patients with suspected non-obstructive coronary artery disease (ANOCA).

Main Results:

  • Low-dose ACh caused more severe epicardial vasoconstriction in the epicardial vasospasm group compared to the microvascular vasospasm group.
  • The equivocal group showed distinct CBF and vascular resistance changes compared to the epicardial vasospasm group.
  • High-dose ACh significantly decreased epicardial diameter and CBF, and increased vascular resistance in vasospastic and equivocal endotypes.

Conclusions:

  • Low-dose ACh suggests intact endothelium in negative and equivocal CAS endotypes.
  • High-dose ACh indicates vascular smooth muscle cell (VSMC) hyperreactivity in epicardial vasospasm, microvascular vasospasm, and equivocal endotypes.
  • The equivocal endotype appears to be a positive test for vasospasm, similar to microvascular vasospasm, with preserved endothelial function.
Abstract

Keywords:
ANOCAANOCA, angina and no obstructive coronary artery diseaseAPV, average peak velocityAcetylcholineCAS, coronary artery spasmCBF, coronary blood flowCOVADIS, Coronary Vasomotor Disorders International Study GroupCoronary artery spasmHaemodynamic changesICFT, invasive coronary vasomotor function testingQCA, quantitative coronary angiographyVSMC, vascular smooth muscle cells

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