Background-Coronary spasm can cause myocardial ischemia and angina in patients with and those without obstructive coronary artery disease. However, provocation tests using intracoronary acetylcholine administration are rarely performed in clinical routine in the United States and Europe. Thus, we assessed the clinical usefulness, angiographic characteristics, and safety of intracoronary acetylcholine provocation testing in white patients with unobstructed coronary arteries. Methods and Results-From September 2007 to June 2010, a total of 921 consecutive patients (362 men, mean age 62±12years) who underwent diagnostic angiography for suspected myocardial ischemia and were found to have unobstructed coronary arteries (no stenosis ≥50%) were enrolled. The intracoronary acetylcholine provocation testing was performed directly after angiography according to a standardized protocol. Three hundred forty-six patients (35%) reported chest pain at rest, 222 (22%) reported chest pain on exertion, 238 (24%) reported a combination of effort and resting chest pain, and 41 (4%) presented with troponin-positive acute coronary syndrome. The overall frequency of epicardial spasm (>75% diameter reduction with angina and ischemic ECG shifts) was 33.4%, and the overall frequency of microvascular spasm (angina and ischemic ECG shifts without epicardial spasm) was 24.2%. Epicardial spasm was most often diffuse and located in the distal coronary segments (P<0.01

No benefit was seen for CTO PCI in terms of the primary endpoint, SWT, or other indexes of left ventricular function. CTO PCI resulted in clinical benefit over no CTO PCI, as evidenced by reduced major adverse coronary event rates at 12 months.

Purpose:To evaluate the ability of strain-encoded (SENC) magnetic resonance imaging (MRI) for regional systolic and diastolic strain analysis of the myocardium in healthy volunteers. Materials and Methods:Circumferential and longitudinal peak systolic strain values of 75 healthy volunteers (35 women and 40 men, mean age 44 Ϯ 12 years) were measured using SENC at 1.5T. MR tagging was used as the reference standard for measuring regional function. Diastolic function was assessed in the 10 youngest (24 Ϯ 8 years) and 10 oldest (62 Ϯ 5 years) subjects. Results:Peak strain values assessed with SENC were comparable to those obtained by MR tagging, showing narrow limits of agreement (limits of agreement -5.6% to 8.1%). Regional heterogeneity was observed between different segments of the left ventricle (LV) by both techniques (P Ͻ 0.001). Longitudinal strain obtained by SENC was also heterogenous (P Ͻ 0.001). Interestingly, no age-or genderspecific differences in peak systolic strain were observed, whereas the peak rate of relaxation of circumferential strain rate was decreased in the older group.Conclusion SENC is a reliable tool for accurate and objective quantification of regional myocardial systolic as well as diastolic function. In agreement with tagged MRI, SENC detected slightly heterogeneous myocardial strain within LV segments.