title: Estimation of coronary flow velocity reserve using transthoracic Doppler echocardiography and cold pressor test might be useful for detecting of patients with variant angina.
abstract: OBJECTIVE
  The cold pressor test (CPT) has been used to detect variant angina, but its sensitivity in predicting vasospasm is low. The aim of this study was to determine whether estimates of the coronary flow velocity reserve (CFVR) in the distal left anterior descending coronary artery (dLAD) using transthoracic echocardiography (TTE) and CPT are useful tool to predict variant angina.
  
  
  METHODS
  65 patients (mean age = 52 +/- 10 years; male:female = 41:24) who had normal coronary artery on angiography and underwent acetylcholine provocation test were enrolled and divided into the spasm group (n = 31) and the no spasm group (n = 34). During CPT, the peak (PDV) and mean diastolic flow velocity (MDV) of the dLAD were estimated using TTE with a high-frequency transducer, and electrocardiography, blood pressures, heart rate, and symptoms were monitored every 30 seconds. CPT%PDV and CPT%MDV were defined as the percentage changes in PDV and MDV during CPT, respectively.
  
  
  RESULTS
  CPT%PDV was 4.99 +/- 23.62% in the spasm group and 52.75 +/- 24.78% in the no spasm group (P < 0.001). CPT%MDV was 6.83 +/- 23.81% in the spasm group and 50.22 +/- 27.83% in the no spasm group (P < 0.001). CPT%PDV<31.1% had a sensitivity of 93.5% and a specificity of 82.4% in predicting variant angina (95% confidence interval [CI]: 0.939-0.979, P < 0.001). CPT%MDV<30.55% had a sensitivity of 90% and a specificity of 76.5% in predicting variant angina (95% CI: 0.884-0.950, P < 0.001).
  
  
  CONCLUSIONS
  The measurement of changes in the coronary flow velocity of the dLAD using TTE and CPT might be useful for the estimation of endothelial dysfunction in patients with variant angina.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 150-713, Korea.
authors.forename: Hui-Jeong
authors.initials: HJ
authors.lastname: Hwang
authors.forename: Woo-Baek
authors.initials: WB
authors.lastname: Chung
authors.forename: Jeong-Hwan
authors.initials: JH
authors.lastname: Park
authors.forename: Su-Sung
authors.initials: SS
authors.lastname: Oh
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Chung
authors.forename: Yun-Seok
authors.initials: YS
authors.lastname: Choi
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
mesh_terms: D000788:Angina Pectoris, Variant / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity