Post-spastic flow recovery time to document vasospasm induced ischemia during acetylcholine provocation testing.
Publication year
2023Source
International journal of cardiology. Heart & vasculature, 47, (2023), pp. 101220, article 101220ISSN
Annotation
01 augustus 2023
Publication type
Article / Letter to editor
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Organization
Cardiology
Journal title
International journal of cardiology. Heart & vasculature
Volume
vol. 47
Page start
p. 101220
Subject
Radboudumc 16: Vascular damage Cardiology; Cardiology - Radboud University Medical CenterAbstract
BACKGROUND: Intracoronary acetylcholine (ACh) provocation is an established method for diagnosing epicardial and microvascular vasospasm in contemporary clinical practice. We hypothesize that ACh-induced vasospasm is followed by post-spastic reactive hyperemia (PSRH), which is measured as an increased flow-recovery time. OBJECTIVES: To assess flow-recovery time, indicative of ischemia, among the diagnostic endotypes that follow ACh provocation testing. METHODS: Patients with angina and non-obstructive coronary artery disease on angiography who underwent ACh provocation testing were included in this analysis. Doppler flow was continuously measured during the procedure and used to determine the flow-recovery time, which was calculated as time between cessation of ACh infusion and the point of flow recovery. RESULTS: Conventional provocation testing according to the COVADIS criteria diagnosed vasospasm in 63%(77/123), an equivocal result in 22%(27/123) and a negative result in 15%(19/123) of patients. In reaction to the highest-dose of ACh, flow-recovery time was significantly extended and similar in the epicardial, microvascular and equivocal test results compared to the negative result (all p < 0.001) indicative of PSRH. CONCLUSION: Flow-recovery time in patients with an equivocal result is similar to patients with vasospasm, which indicates the occurrence of myocardial ischemia and therefore, these patients may benefit from medical treatment.
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- Academic publications [246216]
- Electronic publications [133836]
- Faculty of Medical Sciences [93266]
- Open Access publications [107319]
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