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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
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Prevalence of vasospastic ischaemia induced by the cold pressor test or hyperventilation in patients with severe

K Rasmussen, J P Bagger, J Bøttzauw

    European Heart Journal
    |May 1, 1984
    PubMed

    Insights

    Coronary artery spasm provocation using the cold pressor test and hyperventilation identified significant vasospasm in patients with chest pain. These tests revealed reduced coronary artery diameter, suggesting spasm, not increased oxygen demand, as the cause of ischemia.

    Area of Science:

    • Cardiology
    • Vascular Physiology

    Background:

    • Coronary artery spasm is a significant cause of chest pain and myocardial ischemia.
    • Distinguishing vasospastic angina from other causes of chest pain is crucial for effective treatment.

    Purpose of the Study:

    • To evaluate the efficacy of the cold pressor test (CPT) and hyperventilation (HVT) in provoking coronary artery spasm.
    • To assess the characteristics of patients with positive spasm provocation tests.

    Main Methods:

    • Coronary artery spasm provocation using CPT and HVT in 105 patients undergoing coronary angiography for chest pain.
    • Assessment of ST-segment changes and coronary artery diameter reduction.
    • Comparison of clinical presentation and exercise test results between patients with positive (Group A) and negative (Group B) spasm provocation tests.

    Main Results:

    • A positive spasm provocation response was observed in 23.9% of patients (25/105).
    • Positive responders (Group A) showed significantly greater induced coronary artery diameter reduction (48.3% vs. 9.9%) compared to Group B.
    • Group A patients had a higher incidence of nocturnal angina (88% vs. 38.8%) and positive exercise tests (87% vs. 35.6%).
    • Ischemia induced by CPT or HVT was not associated with increased myocardial oxygen demand.

    Conclusions:

    • CPT and HVT are effective methods for diagnosing coronary artery spasm.
    • Patients with positive spasm provocation tests exhibit distinct clinical features, including nocturnal angina and positive exercise tests.
    • Coronary artery spasm, rather than increased myocardial oxygen demand, is a key mechanism in these patients.

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