Noninvasive Prediction of Angiographic Spasm Provocation Using Trans-Thoracic Doppler Echocardiography in Patients With Coronary Spastic Angina

• Published in: Circulation Journal Vol. 72; no. 10; pp. 1640 - 1644
• Main Authors: Takagi, Atsushi, Hosaka, Motoko, Tsurumi, Yukio, Hagiwara, Nobuhisa, Gunnji, Kazue, Komatsu, Yuki, Ishizuka, Naoko, Arai, Kotaro, Tanimoto, Kyomi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2008
• Subjects: Acetylcholine - administration & dosage; Adult; Aged; Angina Pectoris - chemically induced; Angina Pectoris - diagnostic imaging; Blood Flow Velocity - drug effects; Blood Flow Velocity - physiology; Coronary Angiography - methods; Coronary Circulation - physiology; Coronary flow; Coronary spastic angina; Coronary Vessels - diagnostic imaging; Echocardiography, Doppler; Female; Humans; Male; Middle Aged; Reference Values; Trans-thoracic Doppler echocardiography
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-08-0393

Background In the present study it was examined whether transthoracic Doppler echocardiography (TTDE) would be useful for noninvasive diagnosis of coronary spastic angina (CSA) by assessing coronary arterial tone in the morning. Methods and Results The study population comprised 21 CSA patients and 27 control subjects. All diagnoses were angiographically confirmed by provocation test using acetylcholine. Coronary flow velocity reserve (CFVR) was measured at the distal left anterior descending artery with a frequency of 5.0 MHz ultrasound at baseline and after sublingual administration of nitroglycerin (NTG). Coronary arterial tone was assessed by obtaining the change of CFVR induced by NTG administration (CFVRNTG/Pre). Basal CFVR tended to be lower in CSA patients (2.13±0.63, 2.71±0.67, respectively, p=0.05). CFVR after NTG was significantly higher in CSA patients (3.91±1.10, 3.07±0.74, p=0.003). The CFVRNTG/Pre was significantly higher in CSA patients than in the control subjects (1.90±0.49, 1.15±0.22, p<0.0001). Using a cut-off value of 1.4 in CFVRNTG/Pre, the sensitivity and specificity for the diagnosis of CSA were 91% and 90%, respectively. Conclusion TTDE appeared to be useful for the noninvasive diagnosis of CSA by assessing the coronary arterial tone. (Circ J 2008; 72: 1640 - 1644)