International Journal of Cardiology: Heart & Vasculature (Aug 2023)

Post-spastic flow recovery time to document vasospasm induced ischemia during acetylcholine provocation testing

  • Rutger G.T. Feenstra,
  • Janneke Woudstra,
  • Isa Bijloo,
  • Caitlin E.M. Vink,
  • Coen K.M. Boerhout,
  • Guus A. de Waard,
  • Marianne E. Wittekoek,
  • Robbert J. de Winter,
  • Koen M.J. Marques,
  • Etto C. Eringa,
  • Tim P. van de Hoef,
  • Marcel A.M. Beijk,
  • Yolande Appelman,
  • Jan J. Piek

Journal volume & issue
Vol. 47
p. 101220

Abstract

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Background: Intracoronary acetylcholine (ACh) provocation is an established method for diagnosing epicardial and microvascular vasospasm in contemporary clinical practice. We hypothesize that ACh-induced vasospasm is followed by post-spastic reactive hyperemia (PSRH), which is measured as an increased flow-recovery time. Objectives: To assess flow-recovery time, indicative of ischemia, among the diagnostic endotypes that follow ACh provocation testing. Methods: Patients with angina and non-obstructive coronary artery disease on angiography who underwent ACh provocation testing were included in this analysis. Doppler flow was continuously measured during the procedure and used to determine the flow-recovery time, which was calculated as time between cessation of ACh infusion and the point of flow recovery. Results: Conventional provocation testing according to the COVADIS criteria diagnosed vasospasm in 63%(77/123), an equivocal result in 22%(27/123) and a negative result in 15%(19/123) of patients. In reaction to the highest-dose of ACh, flow-recovery time was significantly extended and similar in the epicardial, microvascular and equivocal test results compared to the negative result (all p < 0.001) indicative of PSRH. Conclusion: Flow-recovery time in patients with an equivocal result is similar to patients with vasospasm, which indicates the occurrence of myocardial ischemia and therefore, these patients may benefit from medical treatment.

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