Role of vasospasm in acute coronary syndrome: insights from ergonovine stress echocardiography.
BACKGROUND
Previous studies have shown that ergonovine stress echocardiography (ESE) may be a valuable noninvasive tool for the diagnosis of vasospasm after the confirmation of no significant fixed stenosis.


RESULTS
From May 1999 to January 2002, 52 patients who presented with acute coronary syndrome (ACS) and had normal or near-normal coronary angiograms were enrolled. A 50 microg bolus of ergonovine was given intravenously at 5-min intervals, until a positive result was observed or a total dose of 350 microg was given. After the ergonovine injection, positive results were found in 25 (48%) of 52 patients: 5 (26%) of 19 with unstable angina, 10 (53%) of 19 non-ST elevation myocardial infarction (MI) and 10 (71%) of 14 patients with ST elevation MI. Using univariate analysis, the elevation of troponin concentration, clinical diagnosis of MI, and ST segment elevation on initial electrocardiographic were significantly associated with positive stress test results.


CONCLUSIONS
Despite the limitation that coronary spasm was not confirmed angiographically with ergonovine provocation, ESE may be a useful technique for the noninvasive diagnosis of vasospasm.
Kim
Moo Hyun
MH
Section of Cardiology, Dong-A Medical College, Busan, South Korea. kmh60@damc.or.kr
Park
En Hee
EH
Yang
Doo Kyung
DK
Park
Tae Ho
TH
Kim
Sang Gon
SG
Yoon
Jin Hyuk
JH
Cha
Kwang Soo
KS
Kum
Dong Sung
DS
Kim
Hye Jin
HJ
Kim
Jong Seong
JS
D000208:Acute Disease; D002637:Chest Pain / Q000453:epidemiology; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D025401:Echocardiography, Stress / Q000379:methods*; D004874:Ergonovine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007564:Japan; D008297:Male; D008875:Middle Aged; D010120:Oxytocics / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking
D010120:Oxytocics; D004874:Ergonovine