Life (Feb 2024)

Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders

  • Filippo Luca Gurgoglione,
  • Luigi Vignali,
  • Rocco Antonio Montone,
  • Riccardo Rinaldi,
  • Giorgio Benatti,
  • Emilia Solinas,
  • Antonio Maria Leone,
  • Domenico Galante,
  • Gianluca Campo,
  • Simone Biscaglia,
  • Italo Porto,
  • Stefano Benenati,
  • Giampaolo Niccoli

DOI
https://doi.org/10.3390/life14030292
Journal volume & issue
Vol. 14, no. 3
p. 292

Abstract

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Coronary vasomotor disorders (CVD) are characterized by transient hypercontraction of coronary vascular smooth muscle cells, leading to hypercontraction of epicardial and/or microvascular coronary circulation. CVDs play a relevant role in the pathogenesis of ischemia, angina and myocardial infarction with non-obstructive coronary arteries. Invasive provocative testing with intracoronary Acetylcholine (ACh) administration is the gold standard tool for addressing CVD, providing relevant therapeutic and prognostic implications. However, safety concerns preclude the widespread incorporation of the ACh test into clinical practice. The purpose of this review is to shed light on the pathophysiology underlying CVD and on the clinical role of the ACh test, focusing on safety profile and prognostic implications. We will also discuss contemporary evidence on the management of CVD and the role of the ACh test in driving a personalized approach of patients with CVD.

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