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[Provocation tests for coronary spasm. Methods, value and indications].

M Bory, M Bénichou, A Egré

    Archives Des Maladies Du Coeur Et Des Vaisseaux
    |April 1, 1983
    PubMed
    Summary
    This summary is machine-generated.

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    Provocation tests effectively diagnose coronary spasm, with ergotamine derivatives and alkalinisation being the most sensitive methods. While specificity is high, sensitivity is moderate, meaning a negative test doesn't rule out spasm.

    Area of Science:

    • Cardiology
    • Diagnostic Medicine

    Background:

    • Coronary spasm diagnosis relies on five methods: ergotamine derivatives, alkalinisation, cold, adenosine triphosphate, and exercise stress testing.
    • Diagnostic criteria include direct coronary angiography visualization or indirect electrocardiographic changes.

    Purpose of the Study:

    • To evaluate the diagnostic value and clinical utility of various coronary spasm provocation tests.
    • To establish the sensitivity, specificity, and reproducibility of these diagnostic methods.

    Main Methods:

    • Review of current diagnostic methods for coronary spasm.
    • Analysis of diagnostic criteria: angiographic visualization vs. electrocardiographic changes.
    • Comparison of provocation methods: ergotamine derivatives, alkalinisation, cold, ATP, and exercise stress testing.

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    Main Results:

    • All methods exhibit excellent specificity (positive test is diagnostic).
    • Sensitivity is moderate; a negative test does not exclude coronary spasm.
    • Ergotamine derivatives and alkalinisation are the most sensitive provocation methods.
    • Reproducibility is satisfactory in both short and long term.

    Conclusions:

    • Diagnostic tests are valuable for unexplained chest pain in patients with normal coronary arteries.
    • Provocation tests aid in selecting adjunctive therapies for patients undergoing coronary bypass surgery.
    • Ergotamine derivative provocation is the preferred method, with alkalinisation as a viable alternative.