title: Acetylcholine versus cold pressor testing for evaluation of coronary endothelial function.
abstract: BACKGROUND
  Assessment of coronary endothelial function with intracoronary acetylcholine (IC-Ach) provides diagnostic and prognostic data in patients with suspected coronary microvascular dysfunction (CMD), but is often not feasible due in part to the time and expertise needed for pharmacologic mixing. Cold pressor testing (CPT) is a simple and safe stimulus useful for either invasive or non-invasive endothelial function testing and myocardial perfusion imaging but has not been specifically evaluated among symptomatic women with signs of ischemic heart disease (IHD) who have no obstructive coronary artery disease (CAD).
  
  
  METHODS
  163 women with signs and symptoms of IHD and no obstructive CAD from the NHLBI- Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study underwent coronary reactivity testing with a Doppler flow wire (FloWire® Volcano, San Diego, CA) in the proximal left anterior descending artery. Coronary artery diameter and coronary blood flow (CBF) assessed by core lab using QCA before and after IC-Ach (18.2 μg/ml infused over 3 minutes) and during CPT.
  
  
  RESULTS
  Mean age was 55 ± 12 years. Rate pressure product (RPP) in response to IC-Ach did not change (baseline to peak, P = 0.26), but increased during CPT (363±1457; P = 0.0028). CBF in response to CPT was poorly correlated to IC-Ach CBF. Change in coronary artery diameter after IC-Ach correlated with change after CPT (r = 0.59, P<0.001). The correlation coefficient was stronger in subjects with coronary dilation to IC-Ach (r = 0.628, P<0.001) versus those without dilation (r = 0.353, P = 0.002), suggesting that other factors may be important to this relationship when endothelium is abnormal.
  
  
  CONCLUSIONS
  In women with no obstructive CAD and suspected CMD, coronary diameter changes with IC-Ach and CPT are moderately-well correlated suggesting that CPT testing may be of some use, particularly among patients with normal endothelial function, however, not an alternative to IC-Ach for diagnosis of coronary endothelial dysfunction.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Ahmed
authors.initials: A
authors.lastname: AlBadri
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Janet
authors.initials: J
authors.lastname: Wei
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Puja K
authors.initials: PK
authors.lastname: Mehta
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Sofy
authors.initials: S
authors.lastname: Landes
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, United States of America.
authors.forename: John W
authors.initials: JW
authors.lastname: Petersen
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, United States of America.
authors.forename: R David
authors.initials: RD
authors.lastname: Anderson
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Bruce
authors.initials: B
authors.lastname: Samuels
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Babak
authors.initials: B
authors.lastname: Azarbal
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, United States of America.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Handberg
authors.affiliation: Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors.forename: Quanlin
authors.initials: Q
authors.lastname: Li
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Margo
authors.initials: M
authors.lastname: Minissian
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: Chrisandra
authors.initials: C
authors.lastname: Shufelt
authors.affiliation: Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, United States of America.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
authors.forename: C Noel
authors.initials: CN
authors.lastname: Bairey Merz
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D003080:Cold Temperature; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000503:physiopathology*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology*; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000109:Acetylcholine