Usefulness of Ergonovine Echocardiography in Patients with Acute Coronary Syndrome and Suspected Variant angina

ABSTRACT

BACKGROUND AND OBJECTIVES: It is well known that coronary spasm can cause acute coronary syndrome (ACS) such as unstable angina or acute myocardial infarction as well as variant angina. But the role of coronary spasm as an initial presentation in ACS is difficult to demonstrate. Therefore we tried to investigate the validity and safety of ergonovine echocardiography in ACS with normal coronary angiogram (CAG) and suspected variant angina. MATERIALS AND METHOD: Since July 1999 to June 2000, 53 consecutive patients were enrolled for this study (mean age 56+/-10, 44 male). Clinical manifestations of the patients are acute myocardial infarction (8), unstable angina (17) and suspected variant angina (28). Ergonovine maleate was administered intravenously (50 microgram at 5 minute intervals up to total cumulative dosage 350 microgram) with continuous echocardiographic monitoring. Positive criteria of this test was reversible regional wall motion abnormality by echocardiography. RESULTS: This test was completed in all patients without major cardiac event or malignant arrhythmia. Forteen patients (14/53, 26%) showed positive test their clinical diagnosis was AMI in 2, unstable angina in 6, and variant angina in 6. Four cases were positive without chest pain or electrocardiographic change. CONCLUSION: Ergonovine echocardiography is a safe and useful method in diagnosing coronary vasospasm in ACS with normal CAG and suspected variant angina without ST segment change.