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Provocative ergonovine testing in patients without obstructive coronary disease
Catheterization and Cardiovascular Diagnosis
|January 1, 1983
Summary
The ergonovine test for coronary artery spasm is unreliable for diagnosing chest pain in patients without obstructive coronary disease. An ischemic electrocardiogram during chest pain strongly predicts a positive test, while other symptoms do not.
Area of Science:
- Cardiology
- Diagnostic Medicine
Background:
- Coronary angiography with ergonovine testing is a common method to diagnose coronary artery spasm.
- Identifying predictors of ergonovine test outcomes is crucial for accurate diagnosis of chest pain in patients without obstructive coronary disease.
Purpose of the Study:
- To identify electrocardiographic (ECG) variables and chest pain characteristics that predict positive ergonovine test results in patients without obstructive coronary disease.
Main Methods:
- Retrospective analysis of 31 patients undergoing ergonovine testing.
- ECG monitoring during chest pain episodes.
- Evaluation of chest pain characteristics (onset, relief, associated symptoms).
Main Results:
- An ischemic ECG during chest pain was highly predictive of a positive ergonovine test (75% vs. 4%, p < 0.001).
- Chest pain characteristics like rest pain, nitroglycerin relief, nausea, vomiting, diaphoresis, or radiation were poor predictors of test outcomes.
- Ergonovine testing showed low yield without ECG evidence of ischemia during pain.
Conclusions:
- Ergonovine testing in patients without obstructive coronary disease is of limited value if the ECG does not show ischemia during chest pain.
- Clinical features of chest pain are unreliable predictors of ergonovine test results.