Although
coronary vasospasm can contribute to the development of
unstable angina, the definite diagnostic method has not been established. The purpose of this study was to determine if
ergonovine echocardiography (detection of regional wall motion abnormality during bedside
ergonovine challenge) after angiographic confirmation of insignificant fixed disease would be useful and safe in detecting
coronary vasospasm in patients with
unstable angina. After control of
chest pain with medications in patients admitted to the coronary care unit under the tentative diagnosis of
unstable angina, diagnostic coronary angiography was performed. All patients with normal or insignificant fixed disease underwent
ergonovine echocardiography after discontinuation of medications for 4+/-1 days. Among 208 consecutive patients enrolled for this study, 75% (156 of 208) showed significant fixed disease in the angiography.
Ergonovine echocardiography was performed in 52 patients with insignificant disease, and
coronary vasospasm was documented in 33 (63%, 33 of 52). No serious procedure-related
arrhythmia or
myocardial infarction occurred.
Esophageal motility disorder and
hypertrophic cardiomyopathy were diagnosed in 6 and 3 patients, respectively.
Chest pain of undetermined etiology was the final diagnosis at discharge in 10 patients (5%, 10 of 208); among them
chest pain redeveloped in 2 patients, and repeated
ergonovine echocardiography revealed positive results. Our data suggest that among patients with the clinical presentation of
unstable angina,
coronary vasospasm is the main cause of
myocardial ischemia in a considerable number of patients with a normal or near-normal angiogram, and
ergonovine echocardiography after confirmation of absence of significant fixed disease is useful and safe for noninvasive diagnosis of
coronary vasospasm in this setting.