Key result
Vasoreactivity testing for coronary artery spasm carries notable diagnostic limitations and procedural risks.
Why the study?
Although recommended as Class I for diagnosing vasospastic angina, vasoreactivity testing carries potential risks and limitations in diagnosing coronary artery spasm.
What are the clinical limitations of using vasoreactivity testing for diagnosing vasospastic angina?
What are the clinical limitations of using vasoreactivity testing for diagnosing vasospastic angina?
Despite being a Class I recommendation in some guidelines, vasoreactivity testing for vasospastic angina has significant clinical limitations that cardiologists must carefully consider.
Testing limitations warrant cautious clinical use; leaves open whether Class I status should persist pending stronger evidence.
BACKGROUND: Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS). HYPOTHESIS: Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm. METHODS: Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I. RESULTS: There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent. CONCLUSIONS: Cardiologists should understand the imperfection of these vasoreactivity tests when diagnosing patients with VSA.
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Sueda et al. (2024) conducted a review in Vasospastic angina. Vasoreactivity testing (intracoronary acetylcholine or ergometrine) was evaluated. Vasoreactivity testing for diagnosing coronary artery spasm carries risks and clinical limitations, such as reproducibility issues and inconclusive results, requiring cautious interpretation.
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