Coronary Microvascular Dysfunction Assessed by Intracoronary Acetylcholine Provocation Testing Is a Frequent Cause of Ischemia and Angina in Patients With Exercise‐Induced Electrocardiographic Changes and Unobstructed Coronary Arteries. Issue 8 (9th April 2014)

• Record Type: Journal Article
• Authors: Ong, Peter; Athanasiadis, Anastasios; Hill, Stephan; Schäufele, Tim; Mahrholdt, Heiko; Sechtem, Udo
• Is Part Of: Clinical cardiology. Volume 37:Issue 8(2014:Aug.)
• Page Start: 462
• Page End: 467
• Publication Date: 2014-04-09
• Subjects: Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22282
• Languages: English
• ISSNs: 0160-9289

Abstract

<abstract abstract-type="main" id="clc22282-abs-0001"> <title>ABSTRACT</title> <sec id="clc22282-sec-0001" sec-type="section"> <title>Background</title> <p id="clc22282-para-0001">The exercise electrocardiogram (ECG) is a standard examination in patients with suspected coronary artery disease. However, despite a pathologic result, many patients undergoing diagnostic coronary angiography do not have any significant epicardial stenosis. In this study, we assessed the relation between a pathologic exercise ECG and coronary microvascular dysfunction in response to intracoronary acetylcholine (ACh) provocation in patients without any relevant epicardial stenosis.</p> </sec> <sec id="clc22282-sec-0002" sec-type="section"> <title>Hypothesis</title> <p>Coronary microvascular dysfunction is significantly more often in patients with angina, unobstructed coronary arteries and a pathologic exercise stress test compared to those without pathologic stress test.</p> </sec> <sec id="clc22282-sec-0003" sec-type="section"> <title>Methods</title> <p id="clc22282-para-0002">This study recruited 137 consecutive patients with exertional angina pectoris who underwent diagnostic coronary angiography between September 2008 and April 2011 (68% women; mean age, 63 ± 10 years). In none of the patients was there a stenosis of >50%. All patients underwent an exercise ECG before angiography and intracoronary ACh provocation testing for assessment of coronary vasomotor responses directly after angiography.</p> </sec> <sec id="clc22282-sec-0004" sec-type="section"> <title>Results</title> <p id="clc22282-para-0003">The exercise ECG showed an abnormal result in 69 patients (50%; ST‐segment depression ≥0.1 mV and/or reproduction of the patient's usual symptoms). The ACh test revealed a coronary vasomotor abnormality (reproduction of the patient's symptoms, ischemic ECG shifts ± diffuse distal vasoconstriction) in 87 patients (64%). Such a result was significantly more often found in patients with a pathologic exercise ECG (50/69 [72%] vs 19/69 [28%], <italic>P</italic> = 0.034). There were no other statistically significant differences between patients with and those without pathologic exercise ECG.</p> </sec> <sec id="clc22282-sec-0005" sec-type="section"> <title>Conclusions</title> <p id="clc22282-para-0004">Coronary microvascular dysfunction is frequently found in patients with exertional angina pectoris and unobstructed coronary arteries. Such a finding is found significantly more often in presence of a pathologic exercise ECG.</p> </sec> </abstract>