Diagnostic values of intravenous ergonovine test with two dimensional echocardiography for induction of coronary vasospasm

Song, Jae Kwan; Park, Seong Wook; Kim, Jae Joong; Doo, Young Cheoul; Kim, Won Ho; Park, Seung Jung; Lee, Jong Koo

Abstract

BACKGROUND
The purpose of this study was to evaluate the clinical feasibility of bedside intravenous ergonovine test with echocardiography as a noninvasive diagnostic method for coronary vasospasm. METHODS: Bedside ergonovine test was performed in 50 patients with chest pain one day after coronary angiography with spasm provocation test ; 30 patients showed positive results of provocation test while in 20 patients there was no evidence of coronary vasospasm. A bolus of ergonovine maleate(0.025 or 0.05mg) was injected at 5 min intervals up to total cumulative dosage of 0.35mg, and 12-leads ECG and 2D-echo were recorded every 3 min after each injection. Left ventricular wall motion was analyzed with a commercially available 'QUAD' system. The positive criteria of bedside ergonovine test included reversible ST segment elevation or depression, T wave changes in ECG(ECG criteria) and reversible regional wall motion abnormalities(RWMA) in Echo(Echo criteria). RESULTS: The overall sensitivity and specificity of ECG criteria were 73%(22/30) and 100% respectively ; The sensitivity of Echo criteria increased up to 90%(27/30) without the change of the specificity. Among 22 patients with reversible ECG changes only 73%(16/22) showed typical ST segment elevation while ST depression was recorded in 2 patients(9%) and minor T wave peaking or flattening without ST segment displacement in 4 patients(18%). Concomitant fixed coronary lesion does increase the sensitivity of the test compared to pure coronary vasospasm with ECG criteria(100% vs 60%, p<0.05). Mean dose of ergonovine with positive result was 173+/-95 microgram(mcg) and the amount of ergonovine for positive result was significantly larger in patients with low disease activity(Chest pain <5 times/week) than those with high disease activity(213+/-83 vs 123+/-86mcg, p<0.01). There was no procedure related mortality or fatal arrhythmias. CONCLUSIONS: Ergonovine echocardiography is a highly sensitive and specific test for coronary vasospasm and is safe in selected patients in whom the exercise test is negative and severe fixed coronary artery disease has been excluded. Presence of concomitant fixed coronary artery disease and the degree of clinical activity of coronary vasospasm may influence the results of this test.