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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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Characterization and implications of intracoronary hemodynamic assessment during coronary spasm provocation testing

Andreas Seitz1, Valeria Martínez Pereyra2, Sarah Froebel2

  • 1Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany. andreas.seitz@rbk.de.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|May 17, 2023
PubMed

Insights

Assessing coronary blood flow (CBF) and resistance (CR) during acetylcholine (ACh) testing offers diagnostic value for coronary spasm. While reduced CBF and increased CR indicate spasm, paradoxical responses warrant further investigation.

Area of Science:

  • Cardiology
  • Vascular Physiology
  • Diagnostic Imaging

Background:

  • Current diagnosis of coronary spasm relies on symptoms, ECG changes, and epicardial vasoconstriction during acetylcholine (ACh) testing.
  • Objective assessment of coronary blood flow (CBF) and resistance (CR) during ACh testing is lacking.

Purpose of the Study:

  • To evaluate the feasibility and diagnostic utility of measuring CBF and CR as objective parameters during ACh spasm testing.
  • To establish the role of intracoronary physiology in diagnosing coronary spasm.

Main Methods:

  • Eighty-nine patients underwent intracoronary reactivity testing with ACh and simultaneous Doppler wire-based measurements of CBF and CR.
  • Coronary spasm (microvascular and epicardial) was diagnosed using COVADIS criteria.

Main Results:

  • Patients with coronary spasm showed a significant decrease in CBF and increase in CR during ACh testing compared to those without spasm (p < 0.01).
  • CBF and CR measurements demonstrated high diagnostic accuracy (AUC 0.86) for identifying coronary spasm.
  • Paradoxical responses (opposite to expected) were observed in 21% of epicardial spasm and 42% of microvascular spasm cases.

Conclusions:

  • Intracoronary assessment of CBF and CR during ACh testing is feasible and diagnostically valuable for coronary spasm.
  • Decreased CBF and increased CR during ACh testing are indicative of coronary spasm.
  • The occurrence of paradoxical responses in a subset of patients necessitates further research into coronary spasm mechanisms.
Abstract

Keywords:
ANOCACoronary spasmMicrovascular dysfunctionVasomotor disorderVasospastic angina

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