Acetylcholine versus cold pressor testing for evaluation of coronary endothelial function

作者：AlBadri Ahmed; Wei Janet; Mehta Puja K; Landes Sofy; Petersen John W; Anderson R David; Samuels Bruce; Azarbal Babak; Handberg Eileen M; Li Quanlin; Minissian Margo; Shufelt Chrisandra; Pepine Carl J; Merz C Noel Bairey^*

来源：PLos One, 2017, 12(2): e0172538.

DOI：10.1371/journal.pone.0172538

Background
Assessment of coronary endothelial function with intracoronary acetylcholine (IC-Ach) provides diagnostic and prognostic data in patients with suspected coronary microvascular dysCMD), but is often not feasible due in part to the time and expertise needed for pharmacologic mixing. Cold pressor testing (CPT) is a simple and safe stimulus useful for either invasive or non-invasive endothelial function testing and myocardial perfusion imaging but has not been specifically evaluated among symptomatic women with signs of ischemic heart disease (IHD) who have no obstructive coronary artery disease (CAD).
Methods
163 women with signs and symptoms of IHD and no obstructive CAD from the NHLBI-Women's lschemia Syndrome Evaluation-Coronary Vascular DysWISE-CVD) study underwent coronary reactivity testing with a Doppler flow wire (FloWire (R) Volcano, San Diego, CA) in the proximal left anterior descending artery. Coronary artery diameter and coronary blood flow (CBF) assessed by core lab using QCA before and after IC-Ach (18.2 mu g/ml infused over 3 minutes) and during CPT.
Results
Mean age was 55 12 years. Rate pressure product (RPP) in response to IC-Ach did not change (baseline to peak, P = 0.26), but increased during CPT (363 +/- 1457; P = 0.0028). CBF in response to CPT was poorly correlated to IC-Ach CBF. Change in coronary artery diameter after IC-Ach correlated with change after CPT (r= 0.59, P<0.001). The correlation coefficient was stronger in subjects with coronary dilation to IC-Ach (r = 0.628, P<0.001) versus those without dilation (r = 0.353, P = 0.002), suggesting that other factors may be important to this relationship when endothelium is abnormal.
Conclusions
In women with no obstructive CAD and suspected CMD, coronary diameter changes with IC-Ach and CPT are moderately-well correlated suggesting that CPT testing may be of some use, particularly among patients with normal endothelial function, however, not an alternative to IC-Ach for diagnosis of coronary endothelial dysfunction.

• 出版日期2017-2-16