New non-invasive protocol for detection of coronary spastic angina with significant organic stenosis

Objectives This study sought to determine whether a newly-combined test, ac celerated exercise following mild hyperventilation (HV) is more beneficial to detect ischaemic evidence in patients with pharmacology-induced coronary artery spasm (CAS) and luminal narrowing of > 75% than classic methods. Methods and Results Forty consecutive patients who all had luminal narrowin g of > 75% but < 90% and pharmacology-induced coronary vasospasms of fixed lesions were involved in this study. In these patients, initial HV test, fo llowed by treadmill (TM) exercise test and lastly the newly combined test w ere performed on three consecutive days. Of the 40 patients, firstly six, s econdarily 16 and lastly 32 had positive responses to the HV test, TM exerc ise test, and newly combined test, respectively. The remaining six patients (15%) had negative results, although the triple sequential tests were perf ormed. Thus, sensitivity of the HV test, the TM exercise test, and the newl y combined test was 15% (6/40), 40% (16/40), and 84% (32/38), respectively. Specificity of the three tests were all 100% (46/46). Non-sustained ventri cular tachycardia and hypotension were observed in two (5%) patients. Howev er, no serious or irreversible complications were encountered in this study . Conclusions We recommend the newly combined protocol rather than the classi c tests for the detection of ischaemic evidence in patients with coronary s pastic angina and fixed stenosis. Coron Artery Dis 12:295-303 (C) 2001 Lipp incott Williams & Wilkins.