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Erschienen in: Herz 4/2016

06.11.2015 | Original Article

Left ventricular end diastolic pressure for detection of intracoronary ergonovine-induced myocardial ischemia

verfasst von: H.-J. Jang, T.-H. Kim, MD, PhD, S.W. Kwon, J.-Y. Kim, J.S. Kim, H.J. Lee, J.S. Park, R.K. Choi, Y.J. Choi, W.-H. Shim

Erschienen in: Herz | Ausgabe 4/2016

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Abstract

Background

Recent consensus on variant angina defines significant spasm as total or subtotal occlusion of a coronary artery. However, the clinical significance of “less-than-subtotal” spasm needs to be reappraised, especially if the coronary spasm is combined with chest pain. Therefore, we evaluated the feasibility of left ventricular end diastolic pressure (LVEDP) as a tool to detect myocardial ischemia during ergonovine provocation testing.

Methods

After achieving two access sites, 29 patients underwent successful LVEDP monitoring using 5-Fr pigtail catheters during ergonovine provocation tests. Patients were divided into two groups based on the occurrence of anginal symptoms.

Results

Of the 29 patients, 16 (55 %) patients had anginal symptoms. LVEDP was significantly increased in the symptomatic group compared with the nonsymptomatic group (∆LVEDP 5.6 ± 4.2 vs. 1.2 ± 2.0 mmHg, p = 0.002). However, of the 16 patients with anginal symptoms, positive provocation test results were confirmed in only six patients (38 %) as per the traditional standard (> 90 % inducible spasm of the epicardial coronary artery).

Conclusion

Compared with the traditional standard, LVEDP may have advantages in terms of elucidating anginal symptoms in patients suspected of having coronary vasospasm when performing ergonovine provocation tests.
Literatur
1.
Zurück zum Zitat Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N (1959) Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med 27:375–388CrossRefPubMed Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N (1959) Angina pectoris. I. A variant form of angina pectoris; preliminary report. Am J Med 27:375–388CrossRefPubMed
2.
Zurück zum Zitat Maseri A, Mimmo R, Chierchia S, Marchesi C, Pesola A, L’Abbate A (1975) Coronary artery spasm as a cause of acute myocardial ischemia in man. Chest 68:625–633CrossRef Maseri A, Mimmo R, Chierchia S, Marchesi C, Pesola A, L’Abbate A (1975) Coronary artery spasm as a cause of acute myocardial ischemia in man. Chest 68:625–633CrossRef
3.
Zurück zum Zitat JCS Joint Working Group (2010) Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS (2008) digest version. Circ J 74:1745–1762CrossRef JCS Joint Working Group (2010) Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS (2008) digest version. Circ J 74:1745–1762CrossRef
4.
Zurück zum Zitat Hauser AM, Gangadharan V, Ramos RG, Gordon S, Timmis GC (1985) Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. J Am Coll Cardiol 5:193–197CrossRefPubMed Hauser AM, Gangadharan V, Ramos RG, Gordon S, Timmis GC (1985) Sequence of mechanical, electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: echocardiographic observations during coronary angioplasty. J Am Coll Cardiol 5:193–197CrossRefPubMed
5.
Zurück zum Zitat Werner GS, Sold G, Teichmann D, Andreas S, Kreuzer H, Wiegand V (1990) Impaired relationship between Doppler echocardiographic parameters of diastolic function and left ventricular filling pressure during acute ischemia. Am Heart J 120:63–72CrossRefPubMed Werner GS, Sold G, Teichmann D, Andreas S, Kreuzer H, Wiegand V (1990) Impaired relationship between Doppler echocardiographic parameters of diastolic function and left ventricular filling pressure during acute ischemia. Am Heart J 120:63–72CrossRefPubMed
6.
Zurück zum Zitat Cannon RO 3rd, Leon MB, Watson RM, Rosing DR, Epstein SE (1985) Chest pain and “normal” coronary arteries-role of small coronary arteries. Am J Cardiol 55:50B–60BCrossRefPubMed Cannon RO 3rd, Leon MB, Watson RM, Rosing DR, Epstein SE (1985) Chest pain and “normal” coronary arteries-role of small coronary arteries. Am J Cardiol 55:50B–60BCrossRefPubMed
7.
Zurück zum Zitat Lansky AJ, Dangas G, Mehran R, Desai KJ, Mintz GS, Wu H, Fahy M, Stone GW, Waksman R, Leon MB (2002) Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation. J Am Coll Cardiol 39:274–280CrossRefPubMed Lansky AJ, Dangas G, Mehran R, Desai KJ, Mintz GS, Wu H, Fahy M, Stone GW, Waksman R, Leon MB (2002) Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation. J Am Coll Cardiol 39:274–280CrossRefPubMed
8.
Zurück zum Zitat Curry RC Jr, Pepine CJ, Sabom MB, Feldman RL, Christie LG, Varnell JH, Conti CR (1978) Hemodynamic and myocardial metabolic effects of ergonovine in patients with chest pain. Circulation 58:648–654CrossRefPubMed Curry RC Jr, Pepine CJ, Sabom MB, Feldman RL, Christie LG, Varnell JH, Conti CR (1978) Hemodynamic and myocardial metabolic effects of ergonovine in patients with chest pain. Circulation 58:648–654CrossRefPubMed
9.
Zurück zum Zitat Heupler FA, Proudfit WL, Razavi M, Shirey EK, Greenstreet R, Sheldon WC (1978) Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol 41:631–639CrossRefPubMed Heupler FA, Proudfit WL, Razavi M, Shirey EK, Greenstreet R, Sheldon WC (1978) Ergonovine maleate provocative test for coronary arterial spasm. Am J Cardiol 41:631–639CrossRefPubMed
10.
Zurück zum Zitat Bertrand ME, Lablanche JM, Tilmant PY (1980) Use of provocative testing in angina pectoris. Herz 5:65–71PubMed Bertrand ME, Lablanche JM, Tilmant PY (1980) Use of provocative testing in angina pectoris. Herz 5:65–71PubMed
11.
Zurück zum Zitat Magder SA, Johnstone DE, Huckell VF, Adelman AG (1981) Experience with ergonovine provocative testing for coronary arterial spasm. Chest 79:638–646CrossRefPubMed Magder SA, Johnstone DE, Huckell VF, Adelman AG (1981) Experience with ergonovine provocative testing for coronary arterial spasm. Chest 79:638–646CrossRefPubMed
12.
Zurück zum Zitat Schroeder JS, Bolen JL, Quint RA, Clark DA, Hayden WG, Higgins CB, Wexler L (1977) Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography. Am J Cardiol 40:487–491CrossRefPubMed Schroeder JS, Bolen JL, Quint RA, Clark DA, Hayden WG, Higgins CB, Wexler L (1977) Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography. Am J Cardiol 40:487–491CrossRefPubMed
13.
Zurück zum Zitat Gravino FN, Perloff JK, Yeatman LA, Ippolitti AF (1981) Coronary arterial spasm versus esophageal spasm. Response to ergonovine. Am J Med 70:1293–1296CrossRefPubMed Gravino FN, Perloff JK, Yeatman LA, Ippolitti AF (1981) Coronary arterial spasm versus esophageal spasm. Response to ergonovine. Am J Med 70:1293–1296CrossRefPubMed
14.
Zurück zum Zitat Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF, FAME Study Investigators (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224CrossRefPubMed Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF, FAME Study Investigators (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224CrossRefPubMed
15.
Zurück zum Zitat Nesto RW, Kowalchuk GJ (1987) The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 59:23C–30CCrossRefPubMed Nesto RW, Kowalchuk GJ (1987) The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 59:23C–30CCrossRefPubMed
16.
Zurück zum Zitat Feldman RL, Hill JA, Whittle JL, Conti CR, Pepine CJ (1983) Electrocardiographic changes with coronary artery spasm. Am Heart J 106:1288–1297CrossRefPubMed Feldman RL, Hill JA, Whittle JL, Conti CR, Pepine CJ (1983) Electrocardiographic changes with coronary artery spasm. Am Heart J 106:1288–1297CrossRefPubMed
17.
Zurück zum Zitat Gertz EW, Wisneski JA, Neese R, Houser A, Korte R, Bristow JD (1980) Myocardial lactate extraction: multi-determined metabolic function. Circulation 61:256–261CrossRefPubMed Gertz EW, Wisneski JA, Neese R, Houser A, Korte R, Bristow JD (1980) Myocardial lactate extraction: multi-determined metabolic function. Circulation 61:256–261CrossRefPubMed
18.
Zurück zum Zitat Wiener L, Kasparian H, Duca PR, Walinsky P, Gottlieb RS, Hanckel F, Brest AN (1976) Spectrum of coronary arterial spasm. Clinical, angiographic and myocardial metabolic experience in 29 cases. Am J Cardiol 38:945–955CrossRefPubMed Wiener L, Kasparian H, Duca PR, Walinsky P, Gottlieb RS, Hanckel F, Brest AN (1976) Spectrum of coronary arterial spasm. Clinical, angiographic and myocardial metabolic experience in 29 cases. Am J Cardiol 38:945–955CrossRefPubMed
19.
Zurück zum Zitat Distante A, Picano E, Moscarelli E, Palombo C, Benassi A, L’abbate A (1985) Echocardiographic versus hemodynamic monitoring during attacks of variant angina pectoris. Am J Cardiol 55:1319–1322CrossRefPubMed Distante A, Picano E, Moscarelli E, Palombo C, Benassi A, L’abbate A (1985) Echocardiographic versus hemodynamic monitoring during attacks of variant angina pectoris. Am J Cardiol 55:1319–1322CrossRefPubMed
20.
Zurück zum Zitat Song JK, Park SW, Kang DH, Hong MK, Kim JJ, Lee CW, Park SJ (2000) Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm. J Am Coll Cardiol 35:1850–1856CrossRefPubMed Song JK, Park SW, Kang DH, Hong MK, Kim JJ, Lee CW, Park SJ (2000) Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm. J Am Coll Cardiol 35:1850–1856CrossRefPubMed
21.
Zurück zum Zitat Hamilton KK, Pepine CJ (2000) A renaissance of provocative testing for coronary spasm? J Am Coll Cardiol 35:1857–1859CrossRefPubMed Hamilton KK, Pepine CJ (2000) A renaissance of provocative testing for coronary spasm? J Am Coll Cardiol 35:1857–1859CrossRefPubMed
22.
Zurück zum Zitat Iskandrian AS, Segal BL, Hakki AH (1981) Left ventricular end-diastolic pressure in evaluating left ventricular function. Clin Cardiol 4:28–33CrossRefPubMed Iskandrian AS, Segal BL, Hakki AH (1981) Left ventricular end-diastolic pressure in evaluating left ventricular function. Clin Cardiol 4:28–33CrossRefPubMed
Metadaten
Titel
Left ventricular end diastolic pressure for detection of intracoronary ergonovine-induced myocardial ischemia
verfasst von
H.-J. Jang
T.-H. Kim, MD, PhD
S.W. Kwon
J.-Y. Kim
J.S. Kim
H.J. Lee
J.S. Park
R.K. Choi
Y.J. Choi
W.-H. Shim
Publikationsdatum
06.11.2015
Verlag
Springer Medizin
Erschienen in
Herz / Ausgabe 4/2016
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-015-4368-2

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