Why the study?
Does intracoronary low-dose acetylcholine provoke microvessel spasm in patients with suspected coronary artery disease and normal angiograms?
Case Report (n=2)
Does intracoronary low-dose acetylcholine provoke microvessel spasm in patients with suspected coronary artery disease and normal angiograms?
Low-dose intracoronary acetylcholine infusion can provoke microvessel spasm and ST-segment elevation in patients with cardiac syndrome X, demonstrating its utility in diagnosing coronary endothelial dysfunction.
May support acetylcholine testing for endothelial dysfunction in cardiac syndrome X; hypothesis-generating, requiring prospective validation.
Endothelial dysfunction plays an important role in the pathogenesis of cardiac syndrome X, and intracoronary low-dose acetylcholine infusion is a widely used diagnostic modality for studying the coronary artery endothelial function. The authors herein report 2 cases of cardiac syndrome X with coronary artery endothelial dysfunction and microvessel spasm. The findings of non-invasive testing were positive for ischemia. Coronary angiograms appeared entirely normal in both cases. However, the intracoronary infusion of low-dose (1.5-15 microg/minute) acetylcholine demonstrated an impairment of the coronary blood flow response and consequently provoked an ST-segment elevation in an electrocardiogram. The coronary angiograms showed no spasm in the epicardial arteries. These patients are thus suggested to have cardiac syndrome X with microvessel spasms associated with coronary artery endothelial dysfunction.
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Masaki et al. (2005) conducted a case report in Suspected coronary artery disease / Cardiac syndrome X (n=2). Intracoronary low-dose acetylcholine infusion was evaluated on Impairment of coronary blood flow response and ST-segment elevation.
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