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Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders
Published on: February 3, 2021
A Review of the Role of Tests of Coronary Reactivity in Clinical Practice
1Department of Cardiology, Ehime Niihama Prefectural Hospital Niihama, Japan.
Insights
Cardiologists should use multiple vasoreactivity tests to accurately diagnose epicardial and microvascular coronary spasms. This approach helps overcome limitations of single tests and avoid pseudonegative results in diagnosing coronary vasomotion disorders.
Area of Science:
- Cardiology
- Clinical Diagnostics
Background:
- Vasoreactivity testing is crucial for diagnosing coronary spasm endotypes like epicardial and microvascular spasm.
- Standard methods include intracoronary acetylcholine and ergonovine, as per the Coronary Vasomotion Disorder (COVADIS) Group guidelines.
Purpose of the Study:
- To highlight the limitations of single vasoreactivity tests in detecting coronary spasm.
- To advocate for the reconsideration of supplementary or sequential vasoreactivity testing.
Main Methods:
- Review of current diagnostic practices for coronary spasm.
- Discussion of the limitations and potential for pseudonegative results in vasoreactivity testing.
Main Results:
- Single vasoreactivity tests can have clinical limitations in documenting coronary spasm.
- Pseudonegative results are often overlooked by clinicians performing these tests.
Conclusions:
- Multiple vasoreactivity tests are recommended to reliably verify the presence or absence of epicardial and microvascular spasms.
- Future practice in cardiac catheterization laboratories should incorporate comprehensive vasoreactivity testing protocols.
Abstract:
Vasoreactivity testing is used by cardiologists in the diagnosis of coronary spasm endotypes, such as epicardial and microvascular spasm. Intracoronary injection of acetylcholine and ergonovine is defined as a standard class I method according to the Coronary Vasomotion Disorder (COVADIS) Group. Because single vasoreactivity testing may have some clinical limitations in detecting the presence of coronary spasm, supplementary or sequential vasoreactivity testing should be reconsidered. The majority of cardiologists do not consider pseudonegative results when performing these vasoreactivity tests. Vasoreactivity testing may have some limitations when it comes to documenting clinical spasm. In the future, cardiologists around the world should use multiple vasoreactivity tests to verify the presence or absence of epicardial and microvascular spasms in the cardiac catheterisation laboratory.
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