Cold pressor test induced left ventricular wall motion abnormalities and reduced coronary reserve in patients with previous LV ballooning syndrome, suggesting microvascular dysfunction.
Case-Control (n=24)
Does cold pressor test induce myocardial perfusion defects and left ventricular dysfunction in patients with previous left ventricular ballooning syndrome?
Patients with previous left ventricular ballooning syndrome exhibit reduced coronary reserve and develop left ventricular wall motion abnormalities during cold pressor testing, suggesting underlying microvascular dysfunction.
AIMS: To investigate whether and how cold pressor test (CPT) could affect myocardial perfusion and left ventricular (LV) function in patients with previous LV ballooning syndrome (LVBS). METHODS AND RESULTS: Cold pressor test (3 min hand immersion in ice-water) was performed in 17 women with previous LVBS and in 7 age- and risk factor-matched women with chest pain and normal coronary arteries. At baseline and peak CPT, global and regional LV function, and myocardial perfusion were quantitatively assessed by real-time three-dimensional echocardiography (RT3DE) and myocardial contrast (SonoVue, Bracco) 2D echocardiography (MCE), respectively (Philips iE33 machine, X3-1 and S5-1 probes). Data were analysed off-line (QLab 6.0 software). Peripheral venous catecholamines were assayed by high performance liquid chromatography with electrochemical detection. Cold pressor test induced similar haemodynamic changes and catecholamine increase in controls and LVBS patients. Left ventricular ejection fraction decreased and transient new mid-ventricular and apical motion abnormalities developed in LVBS patients only (quantitative RT3D analysis), without corresponding perfusion defects (MCE). At peak CPT, coronary blood flow and velocity increased (quantitative MCE analysis) in control subjects only. CONCLUSION: Cold pressor test induced LV wall motion abnormalities unmatched to regional coronary flow reduction in LVBS patients only. The reduced coronary reserve in response to CPT suggests microvascular dysfunction in LVBS patients.
Barletta et al. (2009) conducted a case-control in Previous left ventricular ballooning syndrome (LVBS) (n=24). Cold pressor test vs. Age- and risk factor-matched women with chest pain and normal coronary arteries was evaluated on Myocardial perfusion and left ventricular function. Cold pressor test induced left ventricular wall motion abnormalities and reduced coronary reserve in patients with previous LV ballooning syndrome, suggesting microvascular dysfunction.
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