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Usefulness of Accelerated Exercise Following Mild Hyperventilation for the Induction of Coronary Artery Spasm^*

Comparison With an Acetylcholine Test

^* From the Department of Cardiology (Drs. Sueda, Fukuda, and Watanabe), Saiseikai Saijo Hospital, Saijo City, Japan; and the Department of Cardiology (Drs. Ochi, Kawada, Hayashi, and Uraoka), Kita Medical Association Hospital, Ozu, Japan.

Correspondence to: Shozo Sueda, MD, Department of Cardiology, Saiseikai Saijo Hospital, Tsuitachi 269–1, Saijo City, Ehime Prefecture 793-0027, Japan

Study objectives: This study was performed to compare the results of accelerated exercise following mild hyperventilation and a standard acetylcholine (ACh) test for the induction of coronary artery spasm in patients with drug-induced coronary artery spasm.

Methods and results: The subjects were 74 patients with angiographically confirmed coronary artery spasm who were examined using accelerated exercise (ie, exercise that was accelerated every minute according to the protocol of Bruce and Horsten) following mild hyperventilation and who were not receiving any medication. ACh was injected in incremental doses of 20 µg and 50 µg into the right coronary artery and incremental doses of 20 µg, 50 µg, and 100 µg into the left coronary artery. Positive coronary spasm was defined as 99% luminal narrowing. Accelerated exercise following a mild hyperventilation test was as useful for detecting evidence of ischemia as was an ACh test (48 patients [64.9%] vs 49 patients [66.2%], respectively; not significant). No difference was observed between ischemic changes on ECG as a result of the newly combined method and the occurrence of ACh-induced spasm. ACh-induced coronary vasospasm occurred in 61 patients (82.4%). In the remaining 13 patients, intracoronary administration of ergonovine provoked coronary spasms. No serious irreversible complications were detected as a result of this newly combined method.

Conclusions: The effectiveness of our newly combined procedure is equivalent to that of an ACh test to diagnose patients with coronary artery spasm.

Key Words: accelerated exercise • acetylcholine • coronary spastic angina • hyperventilation

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