Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm

Jae Kwan Song, Seong Wook Park, Duk Hyun Kang, Myeongki Hong, Jae Joong Kim, Cheol Whan Lee, Seung Jung Park

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objectives. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of coronary vasospasm (CVS). Background. The safety of ergonovine provocation for CVS performed outside the catheterization laboratory has been questioned. Methods. We performed a retrospective analysis of the results of bedside ergonovine provocation testing by monitoring left ventricular regional wall motion abnormalities (RWMAs) using two-dimensional echocardiography (Erg Echo). Results. After confirming that there was no significant epicardial coronary stenosis, Erg Echo was performed on 1,372 patients from July 1991 to December 1997. Ergonovine echocardiography was terminated prematurely in 13 patients (0.9%) because of limitations caused by side effects unrelated to myocardial ischemia. Among 1,359 completed tests, 31% (n = 421) showed positive results, with development of RWMAs in 412 tests (98%) or ST displacement in electrocardiograms of nine tests (2%). Arrhythmias developed in 1.9% (26/1,372), including transient ventricular tachycardia (n = 2) and atrioventricular block (n = 4), which were promptly reversed with nitroglycerin. There was no mortality or development of myocardial infarction. Based on the angiographic criteria of 218 patients, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91%, respectively. Since 1994, Erg Echo has become a more popular diagnostic method than invasive spasm provocation testing in the catheterization laboratory and has comprised more than 95% of all spasm provocation tests during the last three years. In the outpatient clinic, 453 patients underwent Erg Echo safely. Conclusions. Although this is a retrospective study in a single center, we believe that Erg Echo is highly feasible, accurate and safe for the diagnosis of CVS and can replace invasive angiographic spasm provocation testing in the catheterization laboratory. (C) 2000 by the American College of Cardiology.

Original languageEnglish
Pages (from-to)1850-1856
Number of pages7
JournalJournal of the American College of Cardiology
Volume35
Issue number7
DOIs
Publication statusPublished - 2000 Jun 1

Fingerprint

Coronary Vasospasm
Ergonovine
Stress Echocardiography
Spasm
Catheterization
Safety
Echocardiography
Atrioventricular Block
Coronary Stenosis
Nitroglycerin
Ventricular Tachycardia
Ambulatory Care Facilities
Myocardial Ischemia
Cardiac Arrhythmias
Electrocardiography
Retrospective Studies
Myocardial Infarction
Sensitivity and Specificity
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Song, Jae Kwan ; Park, Seong Wook ; Kang, Duk Hyun ; Hong, Myeongki ; Kim, Jae Joong ; Lee, Cheol Whan ; Park, Seung Jung. / Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm. In: Journal of the American College of Cardiology. 2000 ; Vol. 35, No. 7. pp. 1850-1856.
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abstract = "Objectives. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of coronary vasospasm (CVS). Background. The safety of ergonovine provocation for CVS performed outside the catheterization laboratory has been questioned. Methods. We performed a retrospective analysis of the results of bedside ergonovine provocation testing by monitoring left ventricular regional wall motion abnormalities (RWMAs) using two-dimensional echocardiography (Erg Echo). Results. After confirming that there was no significant epicardial coronary stenosis, Erg Echo was performed on 1,372 patients from July 1991 to December 1997. Ergonovine echocardiography was terminated prematurely in 13 patients (0.9{\%}) because of limitations caused by side effects unrelated to myocardial ischemia. Among 1,359 completed tests, 31{\%} (n = 421) showed positive results, with development of RWMAs in 412 tests (98{\%}) or ST displacement in electrocardiograms of nine tests (2{\%}). Arrhythmias developed in 1.9{\%} (26/1,372), including transient ventricular tachycardia (n = 2) and atrioventricular block (n = 4), which were promptly reversed with nitroglycerin. There was no mortality or development of myocardial infarction. Based on the angiographic criteria of 218 patients, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93{\%} and 91{\%}, respectively. Since 1994, Erg Echo has become a more popular diagnostic method than invasive spasm provocation testing in the catheterization laboratory and has comprised more than 95{\%} of all spasm provocation tests during the last three years. In the outpatient clinic, 453 patients underwent Erg Echo safely. Conclusions. Although this is a retrospective study in a single center, we believe that Erg Echo is highly feasible, accurate and safe for the diagnosis of CVS and can replace invasive angiographic spasm provocation testing in the catheterization laboratory. (C) 2000 by the American College of Cardiology.",
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Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm. / Song, Jae Kwan; Park, Seong Wook; Kang, Duk Hyun; Hong, Myeongki; Kim, Jae Joong; Lee, Cheol Whan; Park, Seung Jung.

In: Journal of the American College of Cardiology, Vol. 35, No. 7, 01.06.2000, p. 1850-1856.

Research output: Contribution to journalArticle

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T1 - Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm

AU - Song, Jae Kwan

AU - Park, Seong Wook

AU - Kang, Duk Hyun

AU - Hong, Myeongki

AU - Kim, Jae Joong

AU - Lee, Cheol Whan

AU - Park, Seung Jung

PY - 2000/6/1

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N2 - Objectives. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of coronary vasospasm (CVS). Background. The safety of ergonovine provocation for CVS performed outside the catheterization laboratory has been questioned. Methods. We performed a retrospective analysis of the results of bedside ergonovine provocation testing by monitoring left ventricular regional wall motion abnormalities (RWMAs) using two-dimensional echocardiography (Erg Echo). Results. After confirming that there was no significant epicardial coronary stenosis, Erg Echo was performed on 1,372 patients from July 1991 to December 1997. Ergonovine echocardiography was terminated prematurely in 13 patients (0.9%) because of limitations caused by side effects unrelated to myocardial ischemia. Among 1,359 completed tests, 31% (n = 421) showed positive results, with development of RWMAs in 412 tests (98%) or ST displacement in electrocardiograms of nine tests (2%). Arrhythmias developed in 1.9% (26/1,372), including transient ventricular tachycardia (n = 2) and atrioventricular block (n = 4), which were promptly reversed with nitroglycerin. There was no mortality or development of myocardial infarction. Based on the angiographic criteria of 218 patients, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91%, respectively. Since 1994, Erg Echo has become a more popular diagnostic method than invasive spasm provocation testing in the catheterization laboratory and has comprised more than 95% of all spasm provocation tests during the last three years. In the outpatient clinic, 453 patients underwent Erg Echo safely. Conclusions. Although this is a retrospective study in a single center, we believe that Erg Echo is highly feasible, accurate and safe for the diagnosis of CVS and can replace invasive angiographic spasm provocation testing in the catheterization laboratory. (C) 2000 by the American College of Cardiology.

AB - Objectives. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of coronary vasospasm (CVS). Background. The safety of ergonovine provocation for CVS performed outside the catheterization laboratory has been questioned. Methods. We performed a retrospective analysis of the results of bedside ergonovine provocation testing by monitoring left ventricular regional wall motion abnormalities (RWMAs) using two-dimensional echocardiography (Erg Echo). Results. After confirming that there was no significant epicardial coronary stenosis, Erg Echo was performed on 1,372 patients from July 1991 to December 1997. Ergonovine echocardiography was terminated prematurely in 13 patients (0.9%) because of limitations caused by side effects unrelated to myocardial ischemia. Among 1,359 completed tests, 31% (n = 421) showed positive results, with development of RWMAs in 412 tests (98%) or ST displacement in electrocardiograms of nine tests (2%). Arrhythmias developed in 1.9% (26/1,372), including transient ventricular tachycardia (n = 2) and atrioventricular block (n = 4), which were promptly reversed with nitroglycerin. There was no mortality or development of myocardial infarction. Based on the angiographic criteria of 218 patients, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91%, respectively. Since 1994, Erg Echo has become a more popular diagnostic method than invasive spasm provocation testing in the catheterization laboratory and has comprised more than 95% of all spasm provocation tests during the last three years. In the outpatient clinic, 453 patients underwent Erg Echo safely. Conclusions. Although this is a retrospective study in a single center, we believe that Erg Echo is highly feasible, accurate and safe for the diagnosis of CVS and can replace invasive angiographic spasm provocation testing in the catheterization laboratory. (C) 2000 by the American College of Cardiology.

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