Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease
Objectives: To evaluate the utility of higher dose intracoronary acetylcholine (ACh) during invasive coronary function testing (CFT) in women with suspected ischemia and no obstructive coronary artery disease (INOCA) for detection of epicardial vasospasm, relation to quality of life (QoL) and the pr...
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Elsevier
2025-05-01
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| Series: | American Heart Journal Plus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000308 |
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| author | Benita Tjoe Christine Pacheco Nissi Suppogu Bruce Samuels Panteha Rezaeian Balaji Tamarappoo Daniel S. Berman Behzad Sharif Michael Nelson R. David Anderson John Petersen Carl J. Pepine Louise E.J. Thomson C. Noel Bairey Merz Janet Wei |
| author_facet | Benita Tjoe Christine Pacheco Nissi Suppogu Bruce Samuels Panteha Rezaeian Balaji Tamarappoo Daniel S. Berman Behzad Sharif Michael Nelson R. David Anderson John Petersen Carl J. Pepine Louise E.J. Thomson C. Noel Bairey Merz Janet Wei |
| author_sort | Benita Tjoe |
| collection | DOAJ |
| description | Objectives: To evaluate the utility of higher dose intracoronary acetylcholine (ACh) during invasive coronary function testing (CFT) in women with suspected ischemia and no obstructive coronary artery disease (INOCA) for detection of epicardial vasospasm, relation to quality of life (QoL) and the presence of scar by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMRI). Background: CFT is an established method for diagnosis of coronary microvascular dysfunction (CMD). The utility of epicardial vasospasm provocation testing with higher dose ACh infusion is not fully understood. Methods: Women with suspected INOCA undergoing invasive CFT were enrolled in the Women's Ischemia Syndrome Evaluation-Pre-Heart Failure with Preserved Ejection Fraction (WISE Pre-HFpEF) study (NCT03876223). Incremental infusions of 0.364, 36.4 μg and 108 μg ACh were used for vasospasm provocation. Vasospasm was defined as ≥75 % artery diameter reduction compared to post-nitroglycerin diameter and related to QoL and LGE on CMRI. Results: Among 73 women (56 ± 11 years), epicardial vasospasm was detected in 17 (23 %). Among women with vasospasm, the vast majority (94 %) had coronary endothelial dysfunction and few (12 %) had other abnormal CFT measures. Those with vasospasm had more nocturnal angina symptoms, calcium channel blocker use, poorer QoL (all p = 0.001) and disease perception (p = 0.02) than those without. LGE scar by CMRI was not associated with vasospasm (p = 0.22). Conclusions: Among women with suspected INOCA, intracoronary Ach spasm testing provoked epicardial vasospasm in one fourth. Women with epicardial vasospasm overwhelmingly had concomitant endothelial dysfunction, worse QoL but not more frequent myocardial scar on CMRI. |
| format | Article |
| id | doaj-art-4c8ef1c2b5314316a47670e1ec7394a6 |
| institution | DOAJ |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-4c8ef1c2b5314316a47670e1ec7394a62025-08-20T03:18:12ZengElsevierAmerican Heart Journal Plus2666-60222025-05-015310052710.1016/j.ahjo.2025.100527Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery diseaseBenita Tjoe0Christine Pacheco1Nissi Suppogu2Bruce Samuels3Panteha Rezaeian4Balaji Tamarappoo5Daniel S. Berman6Behzad Sharif7Michael Nelson8R. David Anderson9John Petersen10Carl J. Pepine11Louise E.J. Thomson12C. Noel Bairey Merz13Janet Wei14Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USAHôpital Pierre-Boucher, Centre intégré de santé et de services sociaux de la Montérégie-Est, Longueuil, QC, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, CanadaDepartment of Cardiology, University of California Irvine School of Medicine, Orange, CA, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Indiana University School of Medicine, Indianapolis, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Kinesiology, University of Texas, Arlington, USAUniversity of Florida, Gainesville, FL, USAUniversity of Florida, Gainesville, FL, USAUniversity of Florida, Gainesville, FL, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USABarbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Corresponding author at: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 S San Vicente Blvd A3206, Los Angeles, CA 90048, USA.Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USAObjectives: To evaluate the utility of higher dose intracoronary acetylcholine (ACh) during invasive coronary function testing (CFT) in women with suspected ischemia and no obstructive coronary artery disease (INOCA) for detection of epicardial vasospasm, relation to quality of life (QoL) and the presence of scar by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMRI). Background: CFT is an established method for diagnosis of coronary microvascular dysfunction (CMD). The utility of epicardial vasospasm provocation testing with higher dose ACh infusion is not fully understood. Methods: Women with suspected INOCA undergoing invasive CFT were enrolled in the Women's Ischemia Syndrome Evaluation-Pre-Heart Failure with Preserved Ejection Fraction (WISE Pre-HFpEF) study (NCT03876223). Incremental infusions of 0.364, 36.4 μg and 108 μg ACh were used for vasospasm provocation. Vasospasm was defined as ≥75 % artery diameter reduction compared to post-nitroglycerin diameter and related to QoL and LGE on CMRI. Results: Among 73 women (56 ± 11 years), epicardial vasospasm was detected in 17 (23 %). Among women with vasospasm, the vast majority (94 %) had coronary endothelial dysfunction and few (12 %) had other abnormal CFT measures. Those with vasospasm had more nocturnal angina symptoms, calcium channel blocker use, poorer QoL (all p = 0.001) and disease perception (p = 0.02) than those without. LGE scar by CMRI was not associated with vasospasm (p = 0.22). Conclusions: Among women with suspected INOCA, intracoronary Ach spasm testing provoked epicardial vasospasm in one fourth. Women with epicardial vasospasm overwhelmingly had concomitant endothelial dysfunction, worse QoL but not more frequent myocardial scar on CMRI.http://www.sciencedirect.com/science/article/pii/S2666602225000308Epicardial vasospasmCoronary microvascular dysfunctionINOCAAcetylcholine |
| spellingShingle | Benita Tjoe Christine Pacheco Nissi Suppogu Bruce Samuels Panteha Rezaeian Balaji Tamarappoo Daniel S. Berman Behzad Sharif Michael Nelson R. David Anderson John Petersen Carl J. Pepine Louise E.J. Thomson C. Noel Bairey Merz Janet Wei Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease American Heart Journal Plus Epicardial vasospasm Coronary microvascular dysfunction INOCA Acetylcholine |
| title | Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease |
| title_full | Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease |
| title_fullStr | Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease |
| title_full_unstemmed | Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease |
| title_short | Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease |
| title_sort | intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease |
| topic | Epicardial vasospasm Coronary microvascular dysfunction INOCA Acetylcholine |
| url | http://www.sciencedirect.com/science/article/pii/S2666602225000308 |
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