Prognostic implication of ergonovine echocardiography in patients with near normal coronary angiogram or negative stress test for significant fixed stenosis.
OBJECTIVE
The goal of this study was to assess the prognostic value of ergonovine echocardiography (Erg Echo) for diagnosis of coronary vasospasm (CVS) in patients without significant fixed coronary stenosis.


METHODS
Medical records of 650 patients who underwent Erg Echo were reviewed. Before Erg Echo, absence of significant fixed coronary stenosis was confirmed by invasive coronary angiography (CAG) in 316 patients (49%) or by noninvasive confirmation of negative treadmill or normal myocardial perfusion scan in 334 patients (51%). The cardiac events after Erg Echo were tabulated and these included cardiac death, myocardial infarction (MI), readmission due to intractable chest pain.


RESULTS
The average age was 54 +/- 10 years, with 223 women and 427 men. Erg Echo was positive in 237 patients (36%), for whom long-acting calcium channel blocker and nitrates were prescribed. During follow-up (46 +/- 23 months), cardiac events developed in 13% (30 of 237) of the positive Erg Echo group and 3% (14 of 413) of the negative Erg Echo group (P <.001). Incidence of cardiac death was higher in the positive Erg Echo group (3.4% vs 0.7%, P =.022). The 5-year survival rate (93% +/- 3% vs 99% +/- 1%, P =.013) and event-free survival rate (94% +/- 2% vs 77% +/- 6%, P <.001) were significantly lower in the positive Erg Echo group. Smoking (hazards ratio 6.3; 95% CI 1.7-23.5) and multivessel spasm (hazards ratio 37.2, 95% CI, 8.1 to 170.4) were independent factors associated with cardiac death and/or MI.


CONCLUSIONS
Erg Echo for noninvasive diagnosis of CVS in the differential diagnosis of chest pain provides useful prognostic information for patients without significant fixed coronary stenosis and can play a role as a cost-effective diagnostic strategy in these selected patients.
Song
Jae-Kwan
JK
Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Poongnap-dong, Songpa-ku, Seoul, South Korea. jksong@www.amc.seoul.kr
Park
Seong-Wook
SW
Kang
Duk-Hyun
DH
Hong
Myeong-Ki
MK
Lee
Cheol-Whan
CW
Song
Jong Mi
JM
Kim
Jae-Joong
JJ
Park
Seung-Jung
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress / Q000379:methods*; D004874:Ergonovine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013223:Statistics as Topic
D002317:Cardiovascular Agents; D004874:Ergonovine