Safety and clinical impact of ergonovine stress echocardiography for diagnosis of coronary vasospasm
Jae-Kwan Song, MD, FACCa,
Seong-Wook Park, MD, FACCa,
Duk-Hyun Kang, MDa,
Myeong-Ki Hong, MDa,
Jae-Joong Kim, MDa,
Cheol-Whan Lee, MDa and
Seung-Jung Park, MD, FACCa
a Division of Cardiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
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Figure 1 Protocol of ergonovine echocardiography. ECG = electrocardiogram.
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Figure 2 Representative example of ergonovine echocardiography (A and B) and invasive spasm provocation testing during diagnostic coronary angiography (C and D) in a 47-year-old man. Left ventricular wall motion at end-systole recorded in the apical two-chamber view was demonstrated (A and B). Compared with the basal status (A), prominent loss of systolic myocardial thickening in the inferior wall developed with an ergonovine dose of 0.15 mg (B, white arrow), which was compatible with myocardial ischemia due to coronary artery spasm in the right coronary artery territory. Coronary angiogram taken three days later revealed no significant fixed disease. Intravenous injection of ergonovine (E1) provoked total occlusion of the distal right coronary artery (C), and the angiogram after injection of nitroglycerin (N) showed completely normal right coronary artery and relief of total occlusion (D).
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Figure 3 Clinical diagnosis before ergonovine echocardiography.
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Figure 4 Temporal changes of frequency of invasive spasm provocation testing in the catheterization laboratory (A) and increased usage of ergonovine echocardiography (B) for diagnosis of coronary artery spasm.
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Figure 5 Temporal changes of frequency of ergonovine echocardiography performed in the outpatient clinic without hospital admission. Solid bar = outpatient.
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