Systemic alkalosis as a provocative test for coronary artery spasm in patients with infrequent resting chest pain

Weber, Simon; Cabanes, Laure; Simon, Jean-Claude; Letrait, Muriel; Fouchard, J; Guérin, François; Degeorges, M

doi:10.1016/0002-8703(88)90517-0

Cited by 11 publications

(6 citation statements)

References 9 publications

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“…Indeed there should be certain clinical correlations to the appearance of T-wave changes during coronary vasospasm.24) We think it inadequate to include them in the positive criteria because hyperventilation often induces similar ECG findings in normals. 25,26) In agreement with the study of Weber et al,8) no serious complications related to the hyperventilation test occurred in this study. Only 2 patients developed short runs of ventricular premature contractions, but these disappeared before sublingual administration of nitroglycerin.…”

Section: Discussionsupporting

confidence: 93%

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Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

et al. 1995

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SUMMARYTo establish a safe and sensitive diagnostic procedure for detecting coronary vasospasm, we utilized 201-thallium myocardial SPECT combined with hyperventilation (HV-SPECT) in 29 patients with vasospastic angina (VAP) and 11 controls.Twenty-five of 29 patients with VAP and 5 of 11 controls developed transient perfusion defects on HV-SPECT, resulting in a sensitivity and specificity calculated at 86% and 55%, respectively.Overall accuracy in identifying corresponding vessels with coronary vasospasm was 67%; it was 83%, 75% and 42% for patients with 1, 2 and 3 vessel spasm, respectively. Coronary vasospasm tended to be identified more accurately in the left anterior descending branch and the right coronary artery than in the circumflex branch (75%, 71% and 50%, respectively).The hyperventilation test induced ischemic ECG changes in 11 of 29 patients with VAP, yielding a sensitivity of 38%. Analyzing the washout rate of HV-SPECT in patients with VAP, both the extent and severity scores of patients with ischemic ECG changes were larger than those of patients without. No serious complications occurred during HV-SPECT.In conclusion, HV-SPECT was a safe and sensitive procedure as a primary diagnostic approach for VAR From the results of washout analysis, HV-SPECT could detect more mild myocardial ischemia than could the ECG, and seemed quite useful especially for detecting coronary vasospasm accompanied by minimal ischemic ECG changes. (Jpn Heart J 36: 405-420, 1995)

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Section: Discussionsupporting

confidence: 93%

“…3,10,19), and spontaneous ST elevation was recorded in 7 patients (No. 8,9,11,12,13,21,23). In total, the ECG indicated ischemic changes in 17 patients (59%) using noninvasive procedures.…”

Section: Correlation Between the Locality Of Transient Perfusion Defementioning

confidence: 99%

Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

et al. 1995

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“… 106 , 107 An arterial pH > 7.65 confirms effective hyperventilation. 108 , 109 , 110 At the onset of chest pain, hyperventilation should be stopped, and an ECG should be performed to document ischemic changes.…”

Section: Methodsmentioning

confidence: 99%

A Practical Approach to Invasive Testing in Ischemia With No Obstructive Coronary Arteries (INOCA)

et al. 2022

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“…found that among 10 patients with hypocapnic alkalosis‐induced coronary vasospasm, a similar hyperventilation trial, while maintaining eucapnic state, failed to induce coronary vasospasm and ischemia in the same patients 36 . In order to prevent a false negative response to a hyperventilation test, a pH of 7.55 or greater should be attained on the blood gas performed at the end of the 6 min hyperventilation test, 34 given that published studies having generally established a pH of 7.55 or greater as a goal 36,38,39 . It remains unknown whether lower pH would be as effective in inducing coronary vasospasm.…”

Section: Methodology Of Hyperventilation Testingmentioning

confidence: 99%

Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta‐analysis

Boivin‐Proulx,

Marquis‐Gravel,

Rousseau‐Saine

et al. 2024

Eur J Clin Investigation

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BackgroundGiven the limited access to invasive vasospastic reactivity testing in Western Countries, there is a need to further develop alternative non‐invasive diagnostic methods for vasospastic angina (VSA). Hyperventilation testing (HVT) is defined as a class IIa recommendation to diagnose VSA by the Japanese Society of Cardiology.MethodsIn this systematic review and meta‐analysis reported according to the PRISMA statement, we review the mechanisms, methods, modalities and diagnostic accuracy of non‐invasive HVT for the diagnostic of VSA.ResultsA total of 106 articles published between 1980 and 2022 about VSA and HVT were included in the systematic review, among which 16 were included in the meta‐analysis for diagnostic accuracy. Twelve electrocardiogram‐HVT studies including 804 patients showed a pooled sensitivity of 54% (95% confidence intervals [CI]; 30%–76%) and a pooled specificity of 99% (95% CI; 88%–100%). Four transthoracic echocardiography‐HVT studies including 197 patients revealed a pooled sensitivity of 90% (95% CI; 82%–94%) and a pooled specificity of 98% (95% CI; 86%–100%). Six myocardial perfusion imaging‐HVT studies including 112 patients yielded a pooled sensitivity of 95% (95% CI; 63%–100%) and a pooled specificity of 78% (95% CI; 19%–98%). Non‐invasive HVT resulted in a low rate of adverse events, ventricular arrhythmias being the most frequently reported, and were resolved with the administration of nitroglycerin.ConclusionsNon‐invasive HVT offers a safe alternative with high diagnostic accuracy to diagnose VSA in patients with otherwise undiagnosed causes of chest pain.

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Systemic alkalosis as a provocative test for coronary artery spasm in patients with infrequent resting chest pain

Cited by 11 publications

References 9 publications

Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

A Practical Approach to Invasive Testing in Ischemia With No Obstructive Coronary Arteries (INOCA)

Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta‐analysis

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