Effects of ergonovine in patients with and without coronary artery disease.

Curry, R. Charles; Pepine, Carl J.; Sabom, Michael B.; Feldman, Robert L.; Christie, Leonard G.; Conti, C. Richard

doi:10.1161/01.cir.56.5.803

Cited by 198 publications

(39 citation statements)

References 23 publications

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“…A diffuse decrease of approximately 10 to 20 percent in the caliber of the coronary arteries is almost always seen in response to ergonovine, as shown in earlier studies. [3][4][5] The occurrence of narrowing exceeding 75 percent (50 percent in some laboratories) is considered to be diagnostic of spasm in epicardial coronary arteries like in the earlier studies. 3,[6][7][8][9] Administration of anti-vasospastic agents and follow-up echocardiography:…”

Section: Methodsmentioning

confidence: 99%

Effects of Anti-vasospastic Agents in Japanese Patients with Dilated Cardiomyopathy and Coronary Vasospasm.

et al. 2002

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SUMMARYThe pathogenesis of dilated cardiomyopathy (DCM) is unknown, but clinical evidence suggests that coronary vasospasm is associated with the development of DCM in some cases. In the present study, we aimed to clarify the prevalence of coronary vasospasm in patients with DCM, the characteristics of patients with DCM and coronary vasospasm, and the effects of anti-vasospastic agents on patients with DCM and coronary vasospasm. This study included 18 consecutive patients with DCM who underwent cardiac catheterization with ergonovine provocation testing. The patient was diagnosed as having coronary vasospasm if ergonovine induced coronary vasoconstriction ≥75% diameter narrowing was observed compared to the diameter after nitroglycerin administration. Six (33%) patients were found to have coronary vasospasm and anti-vasospastic agents were added after the cardiac catheterization. The prevalence of atrial fibrillation in the patients with DCM and coronary vasospasm was greater than that in DCM without coronary vasospasm [67% vs 8% (P<0.05)]. The left ventricular end-diastolic dimension decreased from 61 mm (56/64) to 55 mm (53/56) (median, 25th/75th percentile, P<0.05) and the left ventricular ejection fraction increased from 36% (32/40) to 47% (46/48) (median, 25th/ 75th percentile, P<0.05) after the administration of anti-vasospastic agents and 4 of the 6 patients improved symptomatically. Therefore, ergonovine provocation testing is useful in identifying patients with DCM and coronary vasospasm, in whom cardiac performance is expected to be improved with anti-vasospastic agent therapy. DCM patients with atrial fibrillation may be a clue for identifying patients with coronary vasospasm. (Jpn Heart J 2002; 43: 333-342)

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Section: Methodsmentioning

confidence: 99%

Effects of Anti-vasospastic Agents in Japanese Patients with Dilated Cardiomyopathy and Coronary Vasospasm.

et al. 2002

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“…substituting (6) in (7) substituiting (1) & (4) in (8) rearranging (9) substituting (la) in (10) rearranging ( …”

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confidence: 99%

Pathophysiology of coronary artery spasm.

Freedman¹,

Richmond²,

Kelly³

1982

Circulation

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SUMMARY Coronary arterial measurements were made from cineangiograms in patients with positive and negative ergonovine tests. In those with positive tests, normal segments of arteries adjacent to the site of spasm and arteries without spasm showed no greater sensitivity to ergonovine than arteries from control patients (20 ± 13% constriction vs 17 ± 12%, NS). In patients with positive and negative ergonovine tests, constriction was measured at lesion sites after ergonovine and compared with values predicted from a geometric theory. The

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“…Spasm occurred at sites where there was no coronary arterial narrowing in three patients (1, 5 and 7), 0-50% coronary arterial narrowing in three patients (2, 8 and 11), and >50% coronary arterial narrowing in five patients (3, 4, 6, 9 and 10). Nine patients (1)(2)(3)(4)(5)(6)(7)8 …”

Section: Resultsmentioning

confidence: 99%

The effects of ergonovine maleate on coronary arterial size.

Cipriano¹,

Guthaner²,

Orlick³

et al. 1979

Circulation

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SUMMARY Changes in coronary arterial size due to ergonovine maleate are described and quantitated in 90 patients -18 with typical angina pectoris, 56 with atypical chest pain, nine with variant angina pectoris, and seven heart transplant (allograft) recipients. We observed two angiographic changes in the diameter of coronary arteries: 1) spasm, which was characterized by occlusion or marked (>85%) focal or diffuse vessel narrowing, or 2) relatively mild and diffuse vessel narrowing, which was interpreted as the normal pharmacologic response to the drug. Serial bolus injections of 0.05 mg, 0.10 mg and 0.25 mg of ergonovine maleate produced diffuse narrowing of the diameter of coronary arteries of 10 ± 1.5%, 16 ± 1.4% and 20 ± 1.3% (mean ± SEM), respectively, in the 72 patients with anginal syndromes who did not develop coronary spasm. The degree of coronary arterial narrowing was the same in heart transplant recipients and in patients with normally innervated hearts who did not develop coronary spasm. We believe the normal pharmacologic response to ergonovine maleate was due to a direct vasoconstrictor action of the drug; this action was independent of neural control extrinsic to the heart. CORONARY ARTERIAL SPASM is recognized as a cause of angina pectoris. In attempts to identify patients with this condition, various pharmacologic agents, including methacholine," 2 epinephrine,2 propranolol,2 and ergonovine maleate (EM),3 have been used to provoke coronary vasospasm during coronary arteriography. EM has been shown to induce coronary artery spasm at sites where spontaneous spasm was observed3' 5, 8 and vasospastic coronary artery disease has been demonstrated during coronary angiography by administering this drug. In this study we describe and quantitate the changes in coronary arterial diameter produced by EM when given to patients with various anginal syndromes. In addition, EM was given to heart transplant (allograft) recipients in an attempt to define the mechanism by which this drug affects coronary arterial size. would be given a drug that produced marked coronary artery narrowing which appeared to explain the cause of chest pain in some patients. Patients were told that we expected the results of the study to yield information that would be helpful in their medical treatment. The 90 patients studied included 47 men and 43 women ranging in age from 25-75 years (mean age 48 years). Eighty-three patients were given EM to determine if their anginal syndromes were related to coronary artery spasm. Eighteen of these 83 had typical angina pectoris produced by exercise and relieved by rest or nitrites. Fitly-six patients had chest pain that was not predictably related to stress or relieved by rest or nitrites, and at the time of study we did not know if their pain was cardiac in origin. Nine patients had variant angina pectoris, characterized by nonexertional chest pain that frequently occurred at night and was accompanied by ST-segment elevation. EM was also given to seven clinically stable heart transplant (all...

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Effects of ergonovine in patients with and without coronary artery disease.

Cited by 198 publications

References 23 publications

Effects of Anti-vasospastic Agents in Japanese Patients with Dilated Cardiomyopathy and Coronary Vasospasm.

Effects of Anti-vasospastic Agents in Japanese Patients with Dilated Cardiomyopathy and Coronary Vasospasm.

Pathophysiology of coronary artery spasm.

The effects of ergonovine maleate on coronary arterial size.

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