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?
18 patients with angina and non-obstructive coronary artery disease (ANOCA) who had undergone invasive coronary functional tests, and 13 healthy controls (total n=31).
Non-invasive coronary functional tests (NI-CFTs) including hyperventilation, dipyridamole stress test, and cold pressor test, assessed by recording coronary blood flow velocity in the left anterior descending coronary artery via transthoracic Doppler echocardiography.
Invasive coronary functional tests (I-CFTs) including acetylcholine provocation test and adenosine stress test (for diagnostic agreement), and a healthy control group (for physiological comparison).
Agreement in coronary abnormalities detected during invasive and non-invasive coronary functional tests.surrogate
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.
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Nello Cambise
Angelo Giuseppe Marino
Fabio De Benedetto
European Cardiology Review
Università Cattolica del Sacro Cuore
Agostino Gemelli University Polyclinic
Fatebenefratelli Hospital
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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.
synapsesocial.com/papers/6a11e4cd5a604c357c21c2ab — DOI: https://doi.org/10.15420/ecr.2025.54
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