Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm

OBJECTIVES We sought to address the issues of safety, feasibility and clini cal impact of noninvasive diagnosis of coronary vasospasm (CVS). BACKGROUND The safety of ergonovine provocation for CVS performed outside t he catheterization laboratory has been questioned. METHODS We performed a retrospective analysis of the results of bedside erg onovine provocation testing by monitoring left ventricular regional wall mo tion abnormalities (RWMas) using two-dimensional echocardiography (Erg Echo ). RESULTS After confirming that there was no significant epicardial coronary stenosis, Erg Echo was performed on 1,372 patients from July 1991 to Decemb er 1997. Ergonovine echocardiography was terminated prematurely in 13 patie nts (0.9%) because of limitations caused by side effects unrelated to myoca rdial ischemia. Among 1,359 completed tests, 31% (n = 421) showed positive results, with development of RWMAs in 412 tests (98%) or ST displacement in electrocardiograms of nine tests (2%). Arrhythmias developed in 1.9% (26/1 ,372), including transient ventricular tachycardia (n = 2) and atrioventric ular block (n = 4), which were promptly reversed with nitroglycerin. There was no mortality or development of myocardial infarction. Based on the angi ographic criteria of 218 patients, the sensitivity and specificity of Erg E cho for the diagnosis of CVS were 93% and 91%, respectively. Since 1994, Er g Echo has become a more popular diagnostic method than invasive spasm prov ocation resting in the catheterization laboratory and has comprised more th an 95% of all spasm provocation tests during the last three years. In the o utpatient clinic, 453 patients underwent Erg Echo safely. CONCLUSIONS Although this is a retrospective study in a single center, we b elieve that Erg Echo is highly feasible, accurate and safe for the diagnosi s of CVS and can replace invasive angiographic spasm provocation testing in the catheterization laboratory. (J Am Coll Cardiol 2000;35: 1850-6) (C) 20 00 by the American College of Cardiology.