Non-invasive hyperventilation testing strongly correlated (Φ coefficient 0.71) with invasive acetylcholine testing for detecting coronary vasospasm in patients with non-obstructed coronary arteries.
Observational (n=31)
Single-blind
No
Do non-invasive coronary functional tests using transthoracic Doppler echocardiography correlate with invasive coronary functional tests in identifying the mechanisms of angina in patients with ANOCA?
Non-invasive coronary functional testing using transthoracic Doppler echocardiography shows high diagnostic agreement with invasive testing in patients with ANOCA, offering a potential non-invasive alternative for assessing angina mechanisms.
Effect estimate: Φ coefficient 0.71
p-value: p=0.002
Background: Invasive coronary functional tests (I-CFTs) can identify the mechanism(s) of angina in patients with non-obstructed coronary arteries (ANOCA). In this study, we assessed whether non-invasive coronary functional tests (NI-CFTs) can also produce reliable results when assessing these mechanisms. Methods: We performed NI-CFTs by recording coronary blood flow velocity (CBFV) in the left anterior descending coronary artery by transthoracic Doppler echocardiography in 18 patients with ANOCA who had undergone I-CFTs (an acetylcholine provocation test and an adenosine stress test) and 13 healthy controls. The NI-CFTs included hyperventilation, a dipyridamole stress test and a cold pressor test. Results: Acetylcholine induced epicardial or coronary microvascular spasm in 11 patients (61.1%), whereas adenosine coronary flow reserve (CFR) was reduced (10% compared to baseline in eight patients (44.4%) and none in the control group (p=0.005). Dipyridamole-CFR was lower in the patient group than in the control group (2.25 ± 0.49 versus 2.76±0.49; p=0.01) and correlated with adenosine-CFR (r=0.75; p<0.001). Full agreement in coronary abnormalities detected during I-CFTs and NI-CFTs (hyperventilation/dipyridamole stress test) was found in 14 patients (77.8%). Furthermore, cold pressor test-CFR was lower in patients than in the control group (1.33 ± 0.18 versus 1.52 ± 0.22; p=0.019); cold pressor test-CFR <1.35 identified three patients who showed both normal I-CFTs and a normal response to hyperventilation and dipyridamole at NI-CFTs. Conclusion: In ANOCA patients, the results of NI-CFTs performed with transthoracic Doppler echocardiography of the left anterior descending coronary artery showed a high correlation with coronary function abnormalities detected using I-CFTs. Our data suggest that NI-CFTs deserve investigation in larger multicentre studies to assess their usefulness in guiding clinical management of ANOCA patients.
Cambise et al. (Tue,) conducted a observational in Angina and non-obstructed coronary arteries (ANOCA) (n=31). Non-invasive coronary functional tests (NI-CFTs) vs. Invasive coronary functional tests (I-CFTs) was evaluated on Correlation between coronary vasoconstriction during hyperventilation test and vasospastic response during invasive acetylcholine test (Φ coefficient 0.71, p=0.002). Non-invasive hyperventilation testing strongly correlated (Φ coefficient 0.71) with invasive acetylcholine testing for detecting coronary vasospasm in patients with non-obstructed coronary arteries.