Diagnostic and Prognostic Value of Ergonovine Echocardiography for Noninvasive Diagnosis of Coronary Vasospasm
| Autor: | Goo Yeong Cho, Jong-Min Song, Sahmin Lee, Seung-Jung Park, Sang Yong Om, Yeongmin Woo, Jae-Kwan Song, Dae-Hee Kim, Seong-Wook Park, Sang Sig Cheong, Sang-Yong Yoo, Duk-Hyun Kang, Minsoo Kim |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Acute coronary syndrome medicine.medical_specialty Coronary Vasospasm Perfusion scanning 030204 cardiovascular system & hematology Coronary Angiography 030218 nuclear medicine & medical imaging Sudden cardiac death Angina 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Interquartile range Internal medicine Republic of Korea Humans Medicine Radiology Nuclear Medicine and imaging Myocardial infarction Ergonovine business.industry Middle Aged Prognosis medicine.disease Echocardiography Coronary vasospasm Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | JACC: Cardiovascular Imaging. 13:1875-1887 |
| ISSN: | 1936-878X |
| DOI: | 10.1016/j.jcmg.2020.03.008 |
| Popis: | This study sought to obtain large-scale evidence supporting the clinical usefulness of ergonovine echocardiography.The role of noninvasive ergonovine provocation testing with echocardiographic monitoring of ventricular wall motion (ergonovine echocardiography) needs to be defined.Clinical data of patients who underwent ergonovine echocardiography in 3 tertiary referral hospitals in South Korea were analyzed.Ergonovine echocardiography was performed in 14,012 patients (mean age 52.8 ± 11.1 years; 6,213 [44.3%] women) after exclusion of significant coronary arterial stenosis by functional (treadmill or perfusion scan, n = 9,824) or anatomic test (invasive or computerized tomographic coronary angiography, n = 4,188). Premature termination developed in 0.4% (n = 51), and a positive result was observed in 2,144 patients (15.3%), with variable frequencies according to the diagnosis (acute coronary syndrome [38.2%], variant angina [31.8%], effort angina [14.9%], aborted sudden cardiac death [17.6%], syncope [9.9%]). There was no mortality or development of myocardial infarction during the test. During median follow-up of 11.4 (interquartile range: 7.2 to 15.8) years, death of any cause and cardiovascular death occurred in 494 and 143 patients, respectively. The 10-year overall (96.7 ± 0.2% vs. 91.5 ± 0.6%; p 0.0001) and cardiovascular mortality-free (99.2 ± 0.1% vs. 96.7 ± 0.4%; p 0.0001) survival rates were lower in patients with positive ergonovine echocardiography. Regarding patients with positive test results, the functional test group and the anatomic test group did not show a significant difference in the survival rates. After adjustment of age and male sex, a positive test was an independent risk factor associated with all-cause mortality (hazard ratio: 1.879, 95% confidence interval: 1.548 to 2.280; p 0.001) and cardiovascular death (hazard ratio: 2.903, 95% confidence interval: 2.061 to 4.089; p 0.001).Ergonovine echocardiography for coronary vasospasm diagnosis could be safely performed even without angiographic documentation of fixed coronary stenosis depending on the clinical presentation, and provided important prognostic implication. Ergonovine echocardiography can replace the invasive spasm provocation testing, which has been overlooked unfairly. |
| Databáze: | OpenAIRE |
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