Ergonovine echocardiography as a screening test for diagnosis of vasospastic angina before coronary angiography

Jae Kwan Song, Simon Jong Koo Lee, Duk Hyun Kang, Sang Sig Cheong, Myeongki Hong, Jae Joong Kim, Seong Wook Park, Seung Jung Park

Research output: Contribution to journalArticle

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Abstract

Objectives. In patients with chest pain suggestive of variant angina, we performed this prospective study to test the specificity and diagnostic validity of ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) as a screening procedure before coronary angiography. Background. Spasm provocation test outside the catheterization room has generally not been accepted as a safe diagnostic method. Methods. Ergonovine echocardiography was performed in 80 consecutive patients with chest pain syndrome after confirmation of negative treadmill or normal stress myocardial perfusion scan results using thallium-201. A bolus of ergonovine maleate was injected at 5-min intervals up to a total cumulative dosage of 0.35 mg with echocardiographic monitoring of left ventricular wall motion. A 12-lead electrocardiogram (ECG) was also recorded every 3 min after each ergonovine injection. Positive test results were development of regional wall motion abnormalities or transient ST segment elevation or depression >0.1 mV in any single lead of the 12-lead ECG. Coronary angiography was undertaken within 2 ± 4 days (mean ± SD) after ergonovine echocardiography, and the spasm provocation test with acetylcholine or ergonovine was performed in patients with normal angiographic findings or lumen diameter narrowing <70%. Results. On the basis of angiographic criteria, 56 patients had coronary vasospasm; this finding was later ruled out in 19 patients with near-normal angiographic results by a negative response on the spasm provocation test. In the remaining five patients, coronary spasm provocation was not performed because they revealed a high degree of fixed stenosis (lumen diameter narrowing 97 ± 4%). Ergonovine echocardiography could diagnose coronary vasospasm before angiography, with a sensitivity of 91% (51 of 56 patients, 95% confidence interval [CI] 84% to 98%) and specificity of 88% (21 of 24 patients, 95% CI 75% to 100%). Of 53 patients showing regional wall motion abnormalities during ergonovine echocardiography, characteristic ST segment elevation in the simultaneously recorded ECG was observed in only 20 (38%).There were no complications, including myocardial infarction or fatal arrhythmia, during the test. Conclusions. Ergonovine echocardiography before coronary angiography is safe and can be used as a reliable diagnostic screening test for coronary vasospasm in patients with negative treadmill or normal stress myocardial perfusion scan results. These findings suggest that invasive coronary angiography can be avoided in selected patients for the diagnosis of vasospastic angina.

Original languageEnglish
Pages (from-to)1156-1161
Number of pages6
JournalJournal of the American College of Cardiology
Volume27
Issue number5
DOIs
Publication statusPublished - 1996 Jan 1

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Ergonovine
Coronary Angiography
Echocardiography
Coronary Vasospasm
Spasm
Electrocardiography
Chest Pain
Routine Diagnostic Tests
Perfusion
Confidence Intervals
Thallium
Catheterization
Acetylcholine
Cardiac Arrhythmias
Angiography
Pathologic Constriction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Song, Jae Kwan ; Lee, Simon Jong Koo ; Kang, Duk Hyun ; Cheong, Sang Sig ; Hong, Myeongki ; Kim, Jae Joong ; Park, Seong Wook ; Park, Seung Jung. / Ergonovine echocardiography as a screening test for diagnosis of vasospastic angina before coronary angiography. In: Journal of the American College of Cardiology. 1996 ; Vol. 27, No. 5. pp. 1156-1161.
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abstract = "Objectives. In patients with chest pain suggestive of variant angina, we performed this prospective study to test the specificity and diagnostic validity of ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) as a screening procedure before coronary angiography. Background. Spasm provocation test outside the catheterization room has generally not been accepted as a safe diagnostic method. Methods. Ergonovine echocardiography was performed in 80 consecutive patients with chest pain syndrome after confirmation of negative treadmill or normal stress myocardial perfusion scan results using thallium-201. A bolus of ergonovine maleate was injected at 5-min intervals up to a total cumulative dosage of 0.35 mg with echocardiographic monitoring of left ventricular wall motion. A 12-lead electrocardiogram (ECG) was also recorded every 3 min after each ergonovine injection. Positive test results were development of regional wall motion abnormalities or transient ST segment elevation or depression >0.1 mV in any single lead of the 12-lead ECG. Coronary angiography was undertaken within 2 ± 4 days (mean ± SD) after ergonovine echocardiography, and the spasm provocation test with acetylcholine or ergonovine was performed in patients with normal angiographic findings or lumen diameter narrowing <70{\%}. Results. On the basis of angiographic criteria, 56 patients had coronary vasospasm; this finding was later ruled out in 19 patients with near-normal angiographic results by a negative response on the spasm provocation test. In the remaining five patients, coronary spasm provocation was not performed because they revealed a high degree of fixed stenosis (lumen diameter narrowing 97 ± 4{\%}). Ergonovine echocardiography could diagnose coronary vasospasm before angiography, with a sensitivity of 91{\%} (51 of 56 patients, 95{\%} confidence interval [CI] 84{\%} to 98{\%}) and specificity of 88{\%} (21 of 24 patients, 95{\%} CI 75{\%} to 100{\%}). Of 53 patients showing regional wall motion abnormalities during ergonovine echocardiography, characteristic ST segment elevation in the simultaneously recorded ECG was observed in only 20 (38{\%}).There were no complications, including myocardial infarction or fatal arrhythmia, during the test. Conclusions. Ergonovine echocardiography before coronary angiography is safe and can be used as a reliable diagnostic screening test for coronary vasospasm in patients with negative treadmill or normal stress myocardial perfusion scan results. These findings suggest that invasive coronary angiography can be avoided in selected patients for the diagnosis of vasospastic angina.",
author = "Song, {Jae Kwan} and Lee, {Simon Jong Koo} and Kang, {Duk Hyun} and Cheong, {Sang Sig} and Myeongki Hong and Kim, {Jae Joong} and Park, {Seong Wook} and Park, {Seung Jung}",
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Ergonovine echocardiography as a screening test for diagnosis of vasospastic angina before coronary angiography. / Song, Jae Kwan; Lee, Simon Jong Koo; Kang, Duk Hyun; Cheong, Sang Sig; Hong, Myeongki; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung.

In: Journal of the American College of Cardiology, Vol. 27, No. 5, 01.01.1996, p. 1156-1161.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ergonovine echocardiography as a screening test for diagnosis of vasospastic angina before coronary angiography

AU - Song, Jae Kwan

AU - Lee, Simon Jong Koo

AU - Kang, Duk Hyun

AU - Cheong, Sang Sig

AU - Hong, Myeongki

AU - Kim, Jae Joong

AU - Park, Seong Wook

AU - Park, Seung Jung

PY - 1996/1/1

Y1 - 1996/1/1

N2 - Objectives. In patients with chest pain suggestive of variant angina, we performed this prospective study to test the specificity and diagnostic validity of ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) as a screening procedure before coronary angiography. Background. Spasm provocation test outside the catheterization room has generally not been accepted as a safe diagnostic method. Methods. Ergonovine echocardiography was performed in 80 consecutive patients with chest pain syndrome after confirmation of negative treadmill or normal stress myocardial perfusion scan results using thallium-201. A bolus of ergonovine maleate was injected at 5-min intervals up to a total cumulative dosage of 0.35 mg with echocardiographic monitoring of left ventricular wall motion. A 12-lead electrocardiogram (ECG) was also recorded every 3 min after each ergonovine injection. Positive test results were development of regional wall motion abnormalities or transient ST segment elevation or depression >0.1 mV in any single lead of the 12-lead ECG. Coronary angiography was undertaken within 2 ± 4 days (mean ± SD) after ergonovine echocardiography, and the spasm provocation test with acetylcholine or ergonovine was performed in patients with normal angiographic findings or lumen diameter narrowing <70%. Results. On the basis of angiographic criteria, 56 patients had coronary vasospasm; this finding was later ruled out in 19 patients with near-normal angiographic results by a negative response on the spasm provocation test. In the remaining five patients, coronary spasm provocation was not performed because they revealed a high degree of fixed stenosis (lumen diameter narrowing 97 ± 4%). Ergonovine echocardiography could diagnose coronary vasospasm before angiography, with a sensitivity of 91% (51 of 56 patients, 95% confidence interval [CI] 84% to 98%) and specificity of 88% (21 of 24 patients, 95% CI 75% to 100%). Of 53 patients showing regional wall motion abnormalities during ergonovine echocardiography, characteristic ST segment elevation in the simultaneously recorded ECG was observed in only 20 (38%).There were no complications, including myocardial infarction or fatal arrhythmia, during the test. Conclusions. Ergonovine echocardiography before coronary angiography is safe and can be used as a reliable diagnostic screening test for coronary vasospasm in patients with negative treadmill or normal stress myocardial perfusion scan results. These findings suggest that invasive coronary angiography can be avoided in selected patients for the diagnosis of vasospastic angina.

AB - Objectives. In patients with chest pain suggestive of variant angina, we performed this prospective study to test the specificity and diagnostic validity of ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) as a screening procedure before coronary angiography. Background. Spasm provocation test outside the catheterization room has generally not been accepted as a safe diagnostic method. Methods. Ergonovine echocardiography was performed in 80 consecutive patients with chest pain syndrome after confirmation of negative treadmill or normal stress myocardial perfusion scan results using thallium-201. A bolus of ergonovine maleate was injected at 5-min intervals up to a total cumulative dosage of 0.35 mg with echocardiographic monitoring of left ventricular wall motion. A 12-lead electrocardiogram (ECG) was also recorded every 3 min after each ergonovine injection. Positive test results were development of regional wall motion abnormalities or transient ST segment elevation or depression >0.1 mV in any single lead of the 12-lead ECG. Coronary angiography was undertaken within 2 ± 4 days (mean ± SD) after ergonovine echocardiography, and the spasm provocation test with acetylcholine or ergonovine was performed in patients with normal angiographic findings or lumen diameter narrowing <70%. Results. On the basis of angiographic criteria, 56 patients had coronary vasospasm; this finding was later ruled out in 19 patients with near-normal angiographic results by a negative response on the spasm provocation test. In the remaining five patients, coronary spasm provocation was not performed because they revealed a high degree of fixed stenosis (lumen diameter narrowing 97 ± 4%). Ergonovine echocardiography could diagnose coronary vasospasm before angiography, with a sensitivity of 91% (51 of 56 patients, 95% confidence interval [CI] 84% to 98%) and specificity of 88% (21 of 24 patients, 95% CI 75% to 100%). Of 53 patients showing regional wall motion abnormalities during ergonovine echocardiography, characteristic ST segment elevation in the simultaneously recorded ECG was observed in only 20 (38%).There were no complications, including myocardial infarction or fatal arrhythmia, during the test. Conclusions. Ergonovine echocardiography before coronary angiography is safe and can be used as a reliable diagnostic screening test for coronary vasospasm in patients with negative treadmill or normal stress myocardial perfusion scan results. These findings suggest that invasive coronary angiography can be avoided in selected patients for the diagnosis of vasospastic angina.

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