Research output: Contribution to journal › Article › Academic › peer-review
Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine. / Feenstra, Rutger G. T.; Boerhout, Coen K. M.; Vink, Caitlin E. M. et al.
In: International journal of cardiology. Heart & vasculature, Vol. 42, 101105, 01.10.2022.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine
AU - Feenstra, Rutger G. T.
AU - Boerhout, Coen K. M.
AU - Vink, Caitlin E. M.
AU - Woudstra, Janneke
AU - Wittekoek, Marianne E.
AU - de Waard, Guus A.
AU - Appelman, Yolande
AU - Eringa, Etto C.
AU - Marques, Koen M. J.
AU - de Winter, Robbert J.
AU - van de Hoef, Tim P.
AU - Beijk, Marcel A. M.
AU - Piek, Jan J.
N1 - Publisher Copyright: © 2022
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background: Vasoreactivity testing with high-dose acetylcholine is considered vasospasm provocation and low-dose as endothelial function testing. Aims: To assess the changes in reaction to low- and high-dose acetylcholine in the endotypes of CAS as defined by the Coronary Vasomotor Disorders International Study Group (COVADIS) working group. Methods: Changes in coronary epicardial diameter, coronary blood flow (CBF) and vascular resistance were determined at low-dose acetylcholine. Results: A total of 88 ANOCA patients were included in this analysis. In the negative group (n = 14) incremental infusion of acetylcholine produced a progressive increase in CBF (p = 0.008). In reaction to low-dose acetylcholine, the epicardial vasospasm group (n = 30) is characterised by epicardial vasoconstriction that is significantly more severe compared to the microvascular vasospasm group (p = 0.004)(n = 23). The equivocal group (n = 21) is characterised by an increase in CBF and reduction in vascular resistance that are both significantly different compared to the epicardial vasospasm group (p = 0.036 and p = 0.007, respectively). High-dose acetylcholine decreased epicardial diameter and CBF significantly in the epicardial vasospasm, microvascular vasospasm and in the equivocal group (all p < 0.05. Vascular resistance increased significantly in the epicardial vasospasm group (p < 0.001) and equivocal group (p = 0.009). Conclusion: In reaction to low-dose acetylcholine the negative and equivocal endotype has haemodynamic changes that suggest intact endothelium. In reaction to high-dose acetylcholine the epicardial vasospasm, microvascular vasospasm and equivocal endotype have hemodynamic changes that suggest VSMC-hyperreactivity. These results suggest that the equivocal endotype is a positive test comparable to microvascular vasospasm in the presence of normal endothelial function.
AB - Background: Vasoreactivity testing with high-dose acetylcholine is considered vasospasm provocation and low-dose as endothelial function testing. Aims: To assess the changes in reaction to low- and high-dose acetylcholine in the endotypes of CAS as defined by the Coronary Vasomotor Disorders International Study Group (COVADIS) working group. Methods: Changes in coronary epicardial diameter, coronary blood flow (CBF) and vascular resistance were determined at low-dose acetylcholine. Results: A total of 88 ANOCA patients were included in this analysis. In the negative group (n = 14) incremental infusion of acetylcholine produced a progressive increase in CBF (p = 0.008). In reaction to low-dose acetylcholine, the epicardial vasospasm group (n = 30) is characterised by epicardial vasoconstriction that is significantly more severe compared to the microvascular vasospasm group (p = 0.004)(n = 23). The equivocal group (n = 21) is characterised by an increase in CBF and reduction in vascular resistance that are both significantly different compared to the epicardial vasospasm group (p = 0.036 and p = 0.007, respectively). High-dose acetylcholine decreased epicardial diameter and CBF significantly in the epicardial vasospasm, microvascular vasospasm and in the equivocal group (all p < 0.05. Vascular resistance increased significantly in the epicardial vasospasm group (p < 0.001) and equivocal group (p = 0.009). Conclusion: In reaction to low-dose acetylcholine the negative and equivocal endotype has haemodynamic changes that suggest intact endothelium. In reaction to high-dose acetylcholine the epicardial vasospasm, microvascular vasospasm and equivocal endotype have hemodynamic changes that suggest VSMC-hyperreactivity. These results suggest that the equivocal endotype is a positive test comparable to microvascular vasospasm in the presence of normal endothelial function.
KW - ANOCA
KW - Acetylcholine
KW - Coronary artery spasm
KW - Haemodynamic changes
UR - http://www.scopus.com/inward/record.url?scp=85135914028&partnerID=8YFLogxK
U2 - 10.1016/j.ijcha.2022.101105
DO - 10.1016/j.ijcha.2022.101105
M3 - Article
C2 - 36017267
VL - 42
JO - International journal of cardiology. Heart & vasculature
JF - International journal of cardiology. Heart & vasculature
SN - 2352-9067
M1 - 101105
ER -
ID: 25732884