Korean Circ J.  2018 Oct;48(10):906-916. 10.4070/kcj.2017.0395.

Ergonovine Stress Echocardiography for the Diagnosis of Vasospastic Angina and Its Prognostic Implications in 3,094 Consecutive Patients

• Song YJ
• Ha SJ
• Lee DS
• Bang WD
• Shin DG
• Woo Y
• Cheong S
• Yoo SY

• KMID: 2420642
• DOI: http://doi.org/10.4070/kcj.2017.0395

Abstract

BACKGROUND AND OBJECTIVES
Ergonovine stress echocardiography (ErgECHO) has been proposed as a noninvasive tool for the diagnosis of coronary vasospasm. However, concern over the safety of ErgECHO remains. This study was undertaken to investigate the safety and prognostic value of ErgECHO in a large population.
METHODS
We studied 3,094 consecutive patients from a single-center registry who underwent ErgECHO from November 2002 to June 2009. Medical records, echocardiographic data, and laboratory findings obtained from follow-up periods were analyzed.
RESULTS
The overall positive rate of ErgECHO was 8.6%. No procedure-related mortality or myocardial infarction (MI) occurred. Nineteen patients (0.6%) had transient symptomatic complications during ErgECHO including one who was successfully resuscitated. Cumulative major adverse cardiac events (MACEs) occurred in 14.0% and 5.1% of the patients with positive and negative ErgECHO results, respectively (p < 0.001) at a median follow-up of 10.5 years. Cox regression survival analyses revealed that male sex, age, presence of diabetes, total cholesterol level of >220 mg/dL, and positive ErgECHO result itself were independent factors associated with MACEs.
CONCLUSIONS
ErgECHO can be performed safely by experienced physicians and its positive result may be an independent risk factor for long-term adverse outcomes. It may also be an alternative tool to invasive ergonovine-provoked coronary angiography for the diagnosis of vasospastic angina.

Keyword

Coronary vasospasm; Ergonovine; Echocardiography; Safety; Prognosis

MeSH Terms

Cholesterol
Coronary Angiography
Coronary Vasospasm
Diagnosis*
Echocardiography
Echocardiography, Stress*
Ergonovine*
Follow-Up Studies
Humans
Male
Medical Records
Mortality
Myocardial Infarction
Prognosis
Risk Factors
Cholesterol
Ergonovine

Figure

• 

  Figure 1 Clinical symptoms or diagnoses of the 3,094 study patients before undergoing ErgECHO. The pie chart shows the frequency and distribution of the initial clinical symptoms or diagnoses of the 3,094 study patients. AMI = acute myocardial infarction; DOE = dyspnea on effort; ErgECHO = ergonovine stress echocardiography; UA = unstable angina; VSA = vasospastic angina.

• 

  Figure 2 Results of ErgECHO according to initial clinical symptoms and diagnosis (n=3,094). The vertical axis represents the initial diagnosis or symptoms before undergoing ErgECHO. The black areas show the proportion of patients with positive results; and the white areas, proportion of patients with negative results. The numbers within each bar represent the number of patients. AMI = acute myocardial infarction; DOE = dyspnea on effort; ErgECHO = ergonovine stress echocardiography; UA = unstable angina; VSA = vasospastic angina.

• 

  Figure 3 Frequency and distribution of coronary vasospasm territories during ErgECHO (n=265). Three patients had ischemic ECG changes but no RWMAs (brown area). ECG = electrocardiography; ErgECHO = ergonovine stress echocardiography; LAD = left anterior descending artery; LCX = left circumflex artery; MULTI = multi-vessel territory; RCA = right coronary artery; RWMA = regional wall motion abnormality.

• 

  Figure 4 Kaplan-Meier estimates of cumulative MACEs-free survival curves in the patients grouped according to ErgECHO result. The figure shows the Kaplan-Meier estimate of the cumulative MACE-free survival. The mean and median follow-up durations were 10.4 and 10.5 years, respectively. In the comparison with stratification according to ErgECHO result, the HR for MACEs was 2.951 (95.1% CI, 2.055–4.236; p<0.001). CI = confidence interval; ErgECHO = ergonovine stress echocardiography; HR = hazard ratio; MACEs = major adverse cardiac events.

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