Teragawa H, Oshita C, Uchimura Y. Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test? World J Cardiol 2024; 16(1): 16-26 [PMID: 38313387 DOI: 10.4330/wjc.v16.i1.16]
Corresponding Author of This Article
Hiroki Teragawa, FACC, FACP, FAHA, FESC, MD, PhD, Chief Physician, Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroki-teragawa@jrhh.or.jp
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Jan 26, 2024; 16(1): 16-26 Published online Jan 26, 2024. doi: 10.4330/wjc.v16.i1.16
Do changes in intracoronary pressure aid coronary spasm diagnosis using the spasm provocation test?
Hiroki Teragawa, Chikage Oshita, Yuko Uchimura
Hiroki Teragawa, Chikage Oshita, Yuko Uchimura, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Author contributions: Oshita C and Uchimura Y contributed to the acquisition of data and Teragawa H contributed to the writing and revision of the manuscript; All the authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the JR Hiroshima Hospital Institutional Review Board, No. 2023-11.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Hiroki Teragawa, Yuko Uchimura and Chikage Oshita have no Conflict-of-interest statement regarding the present manuscript.
Data sharing statement: No additional data not shown in this paper are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hiroki Teragawa, FACC, FACP, FAHA, FESC, MD, PhD, Chief Physician, Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan. hiroki-teragawa@jrhh.or.jp
Received: September 27, 2023 Peer-review started: September 27, 2023 First decision: November 28, 2023 Revised: December 11, 2023 Accepted: December 28, 2023 Article in press: December 28, 2023 Published online: January 26, 2024 Processing time: 113 Days and 4.8 Hours
Abstract
BACKGROUND
Although the spasm provocation test (SPT) can diagnose coronary spasms, it would be helpful if it could also predict their occurrence.
AIM
To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.
METHODS
Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure. During each SPT, the pressure wire was advanced into the distal portion of the right coronary artery (RCA) and left anterior descending coronary artery, and the ratio of intracoronary pressure to aortic pressure (Pd/Pa) was monitored. Coronary spasm was defined as an arterial narrowing of > 90% in response to the administration of acetylcholine (ACh), with chest symptoms and/or ischemic electrocardiographic changes. ACh was administered to the RCA at low, moderate, or high doses of 20, 50, or 80 µg, respectively, and to the left coronary artery (LCA) at low, moderate, or high doses of 50, 100, or 200 µg, respectively. Coronary arteries with coronary spasms at low doses of ACh were defined as group L, and those with coronary spasms at moderate or high doses were defined as group MH. Those who did not occur coronary spasms at any ACh dose were designated as group N.
RESULTS
Among the 132 coronary arteries assessed using a pressure wire, there were 49 in group N, 25 in group L, and 58 in group MH. Baseline Pd/Pa was the lowest in group L (P = 0.001). The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N (P < 0.001). A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95, with a sensitivity of 0.600 (15/25) and a specificity of 0.713 (76/107) and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was −0.04, with a sensitivity of 0.741 (43/58) and a specificity of 0.694 (34/49).
CONCLUSION
These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.
Core Tip: The spasm provocation test (SPT) is a well-established tool for diagnosing coronary spasms. However, it is associated with several complications that can make the test a stressful experience. We investigated whether coronary spasms detected in the SPT can be estimated using intracoronary artery pressure measured with a pressure wire. We found that coronary spasms induced by low acetylcholine doses were associated with decreased intracoronary pressure at baseline. Coronary spasms induced by moderate-to-high acetylcholine doses showed decreased intracoronary pressure from baseline to low acetylcholine doses. These indices of intracoronary pressure may be used to predict coronary spasms.
