Key result
Intracoronary acetylcholine provokes epicardial vasospasm in 25% of women with suspected INOCA, linked to worse QoL.
Why the study?
The utility of epicardial vasospasm provocation testing with higher dose intracoronary acetylcholine infusion during invasive coronary function testing is not fully understood.
Does higher dose intracoronary acetylcholine provocation testing detect epicardial vasospasm and relate to quality of life and myocardial scar in women with suspected INOCA?
Does higher dose intracoronary acetylcholine provocation testing detect epicardial vasospasm and relate to quality of life and myocardial scar in women with suspected INOCA?
Intracoronary acetylcholine provocation testing identifies epicardial vasospasm in approximately 25% of women with suspected INOCA, correlating with worse quality of life and endothelial dysfunction but not myocardial scar.
Should not yet change INOCA management; hypothesis-generating association warrants prospective trials.
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: = 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.
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Tjoe et al. (2025) studied this question. Intracoronary acetylcholine testing provoked epicardial vasospasm in 25% of women with suspected INOCA, which was associated with concomitant endothelial dysfunction and worse quality of life.
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