Related Experiment Video

Updated: May 16, 2025

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

15.6K

Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery

Benita Tjoe1, Christine Pacheco2,3, Nissi Suppogu4

  • 1Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

American Heart Journal Plus : Cardiology Research and Practice
|April 4, 2025
PubMed

Insights

Higher dose acetylcholine testing in women with INOCA detected epicardial vasospasm in 23%. These women experienced worse quality of life but no increased myocardial scar.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Clinical Medicine

Background:

  • Coronary microvascular dysfunction (CMD) is diagnosed using coronary function testing (CFT).
  • The effectiveness of higher-dose acetylcholine (ACh) infusion for epicardial vasospasm provocation in CFT is not well-established.
  • Investigating epicardial vasospasm is crucial for understanding ischemia in women with INOCA.

Purpose of the Study:

  • To assess the utility of higher-dose intracoronary ACh during invasive CFT for detecting epicardial vasospasm in women with suspected INOCA.
  • To examine the relationship between epicardial vasospasm, quality of life (QoL), and myocardial scar presence (late gadolinium enhancement on CMRI).

Main Methods:

  • Women with suspected INOCA underwent invasive CFT as part of the WISE Pre-HFpEF study.
  • Incremental infusions of ACh (0.364, 36.4, and 108 μg) were administered for vasospasm provocation.
  • Vasospasm was defined as ≥75% reduction in artery diameter post-nitroglycerin; associations with QoL and LGE on CMRI were analyzed.

Main Results:

  • Epicardial vasospasm was detected in 17 (23%) of 73 women.
  • Women with vasospasm predominantly had coronary endothelial dysfunction (94%) and poorer QoL (p=0.001).
  • Myocardial scar by LGE on CMRI was not associated with vasospasm (p=0.22).

Conclusions:

  • Intracoronary ACh spasm testing identified epicardial vasospasm in approximately one-fourth of women with suspected INOCA.
  • Epicardial vasospasm in this cohort was strongly linked to endothelial dysfunction and reduced QoL.
  • No association was found between epicardial vasospasm and myocardial scar detected by CMRI.
Abstract

Keywords:
AcetylcholineCoronary microvascular dysfunctionEpicardial vasospasmINOCA

More Related Videos

Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration07:59

Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration

Published on: April 4, 2022

1.2K
Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders05:58

Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders

Published on: February 3, 2021

3.3K

Related Concept Videos

Antianginal Drugs: Calcium Channel Blockers and Ranolazine01:25

Antianginal Drugs: Calcium Channel Blockers and Ranolazine

Angina pectoris, a primary symptom of ischemic heart disease, requires careful pharmacological interventions. In this context, calcium channel blockers (CCBs) and ranolazine have emerged as crucial pharmacotherapeutic agents, providing deep insights into the complexities of angina management.
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
409
Antianginal Drugs: Nitrates and β-Blockers01:16

Antianginal Drugs: Nitrates and β-Blockers

In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
Organic nitrates,  such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow....
459
Ischemic Heart Disease: Overview01:17

Ischemic Heart Disease: Overview

Ischemic heart disease occurs when the heart's blood supply dwindles, causing an ominous lack of oxygen and nutrients. This deficiency, stemming from reduced or obstructed blood flow, spells danger, leading to heart muscle damage and dysfunction.
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
1.1K
Indirect-Acting Cholinergic Agonists: Pharmacological Actions01:30

Indirect-Acting Cholinergic Agonists: Pharmacological Actions

Indirect-acting cholinergic agonists, also known as anticholinesterases, exert their pharmacological effects by enhancing cholinergic transmission in various body parts, including the neuromuscular junction, autonomic cholinergic synapses, and the brain.
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
579
Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

Direct-Acting Cholinergic Agonists: Therapeutic Uses

Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren...
646