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

Linksventrikulärer enddiastolischer Druck zur Detektion Ergonovin-induzierter Myokardischämie

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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.

Zusammenfassung

Hintergrund

Im bestehenden Konsensus zur vasospastischen Angina (Prinzmetal-/Variant-Angina) wird ein signifikanter Spasmus als totale oder subtotale Okklusion einer Koronararterie definiert. Doch die klinische Bedeutung eines „weniger als subtotalen“ Koronarspasmus sollte neu bewertet werden, vor allem, wenn er mit thorakalen Schmerzen einhergeht. Daher wurde die Eignung des linksventrikulären enddiastolischen Drucks (LVEDP) als Tool für die Detektion einer Myokardischämie während eines Provokationstests mit Ergonovin (Ergometrin) evaluiert.

Methoden

Nach Erreichen zweier Zugänge war das LVEDP-Monitoring mittels 5-F-Pigtail-Kathetern während eines Ergonovin-Provokationstests bei 29 Patienten erfolgreich.

Ergebnisse

Anhand des Auftretens von Symptomen wurden die Patienten in 2 Gruppen eingeteilt, 16 (55 %) der 29 Patienten hatten pektanginöse Beschwerden. Der LVEDP war in der Gruppe mit Symptomatik signifikant höher als in der Gruppe ohne (LVEDP 5,6 ± 4,2 vs. 1,2 ± 2,0 mmHg, p = 0,002). Doch von den 16 Patienten mit pektanginösen Beschwerden wurde der positive Provokationstest bei nur 6 (38 %) als dem traditionellen Standard (> 90 % des induzierbaren Spasmus bei der epikardialen Koronararterie) entsprechend bestätigt.

Schlussfolgerungen

Verglichen mit dem traditionellen Standard könnte die LVEDP-Bestimmung Vorteile bieten im Zusammenhang mit der Aufklärung pektanginöser Symptome bei Verdacht auf einen Koronarspasmus unter Ergonovin-Provokation.

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Authors and Affiliations

  1. Division of Cardiology, Sejong General Hospital, Bucheon-si, Gyeonggi-do Korea, Republic of Korea

    H.-J. Jang, T.-H. Kim MD, PhD, J.S. Kim, H.J. Lee, J.S. Park, R.K. Choi, Y.J. Choi & W.-H. Shim

  2. Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea

    S.W. Kwon

  3. Division of Neurology, Inje University Seoul Paik Hospital, Seoul, Republic of Korea

    J.-Y. Kim

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  1. H.-J. Jang
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Correspondence to T.-H. Kim MD, PhD.

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Conflict of interest

H.-J. Jang, T.-H. Kim, S. W. Kwon, J.-Y. Kim, J. S. Kim, H. J. Lee, J. S. Park, R. K. Choi, Y. J. Choi and W.-H. Shim state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Jang, HJ., Kim, TH., Kwon, S. et al. Left ventricular end diastolic pressure for detection of intracoronary ergonovine-induced myocardial ischemia. Herz 41, 320–325 (2016). https://doi.org/10.1007/s00059-015-4368-2

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  • DOI: https://doi.org/10.1007/s00059-015-4368-2

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