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Characterization and implications of intracoronary hemodynamic assessment during coronary spasm provocation testing

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Abstract

Background

Current diagnostic criteria for coronary spasm are based on patient’s symptoms, ECG shifts and epicardial vasoconstriction during acetylcholine (ACh) spasm testing.

Aims

To assess the feasibility and diagnostic value of coronary blood flow (CBF) and resistance (CR) assessment as objective parameters during ACh testing.

Methods

Eighty-nine patients who underwent intracoronary reactivity testing including ACh testing with synchronous Doppler wire-based measurements of CBF and CR were included. Coronary microvascular and epicardial spasm, respectively, were diagnosed based on COVADIS criteria.

Results

Patients were 63 ± 13 years old, predominantly female (69%) and had preserved LV ejection fraction (64 ± 8%). Overall, assessment of CBF and CR during ACh testing revealed a decrease in CBF of 0.62 (0.17–1.53)-fold and an increase of CR of 1.45 [0.67–4.02]-fold in spasm patients compared to 2.08 (1.73–4.76) for CBF and 0.45 (0.44–0.63) for CR in patients without coronary spasm (both p < 0.01). Receiver operating characteristic revealed a high diagnostic ability of CBF and CR (AUC 0.86, p < 0.001, respectively) in identifying patients with coronary spasm. However, in 21% of patients with epicardial spasm and 42% of patients with microvascular spasm a paradoxical response was observed.

Conclusions

This study demonstrates feasibility and potential diagnostic value of intracoronary physiology assessments during ACh testing. We observed opposite responses of CBF and CR to ACh in patients with positive vs. negative spasm test. While a decrease in CBF and an increase in CR during ACh seem pathognomonic for spasm, some patients with coronary spasm demonstrate paradoxical ACh response demanding further scientific investigations.

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Abbreviations

ACh:

Acetylcholine

ANOCA:

Angina and non-obstructive coronary arteries

APV:

Average peak flow velocity

CAD:

Coronary artery disease

CBF:

Coronary blood flow

COVADIS:

Coronary vasomotor disorders international study group

CR:

Coronary resistance

TIMI:

Thrombolysis in myocardial infarction

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Funding

This work was supported by the Robert-Bosch-Foundation, Stuttgart, Germany, and the Berthold-Leibinger-Foundation, Ditzingen, Germany.

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Authors and Affiliations

  1. Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany

    Andreas Seitz, Valeria Martínez Pereyra, Sarah Froebel, Astrid Hubert, Johanna McChord, Raffi Bekeredjian, Udo Sechtem & Peter Ong

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  1. Andreas Seitz
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  2. Valeria Martínez Pereyra
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  3. Sarah Froebel
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Correspondence to Andreas Seitz.

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Seitz, A., Martínez Pereyra, V., Froebel, S. et al. Characterization and implications of intracoronary hemodynamic assessment during coronary spasm provocation testing. Clin Res Cardiol 112, 1312–1321 (2023). https://doi.org/10.1007/s00392-023-02224-1

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  • DOI: https://doi.org/10.1007/s00392-023-02224-1

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