Author + information
- Received December 28, 2019
- Revision received March 3, 2020
- Accepted March 5, 2020
- Published online May 13, 2020.
- Sang Yong Om, MDa,∗,
- Sang-Yong Yoo, MDb,∗,
- Goo-Yeong Cho, MDc,∗,
- Minsoo Kim, MDa,
- Yeongmin Woo, MDb,
- Sahmin Lee, MDa,
- Dae-Hee Kim, MDa,
- Jong-Min Song, MDa,
- Duk-Hyun Kang, MDa,
- Sang Sig Cheong, MDb,
- Seong-Wook Park, MDa,
- Seung-Jung Park, MDa and
- Jae-Kwan Song, MDa,∗ ()
- aDivision of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
- bDivision of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
- cDivision of Cardiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- ↵∗Address for correspondence:
Dr. Jae-Kwan Song, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Objectives The study sought to obtain large-scale evidence supporting the clinical usefulness of ergonovine echocardiography.
Background The role of noninvasive ergonovine provocation testing with echocardiographic monitoring of ventricular wall motion (ergonovine echocardiography) needs to be defined.
Methods Clinical data of patients who underwent ergonovine echocardiography in 3 tertiary referral hospitals in South Korea were analyzed.
Results Ergonovine echocardiography was performed in 14,012 patients (mean age 52.8 ± 11.1 years; 6,213 [44.3%] women) after exclusion of significant coronary arterial stenosis by functional (treadmill or perfusion scan, n = 9,824) or anatomic test (invasive or computerized tomographic coronary angiography, n = 4,188). Premature termination developed in 0.4% (n = 51), and a positive result was observed in 2,144 patients (15.3%), with variable frequencies according to the diagnosis (acute coronary syndrome [38.2%], variant angina [31.8%], effort angina [14.9%], aborted sudden cardiac death [17.6%], syncope [9.9%]). There was no mortality or development of myocardial infarction during the test. During median follow-up of 11.4 (interquartile range: 7.2 to 15.8) years, death of any cause and cardiovascular death occurred in 494 and 143 patients, respectively. The 10-year overall (96.7 ± 0.2% vs. 91.5 ± 0.6%; p < 0.0001) and cardiovascular mortality–free (99.2 ± 0.1% vs. 96.7 ± 0.4%; p < 0.0001) survival rates were lower in patients with positive ergonovine echocardiography. Regarding patients with positive test results, the functional test group and the anatomic test group did not show a significant difference in the survival rates. After adjustment of age and male sex, a positive test was an independent risk factor associated with all-cause mortality (hazard ratio: 1.879, 95% confidence interval: 1.548 to 2.280; p < 0.001) and cardiovascular death (hazard ratio: 2.903, 95% confidence interval: 2.061 to 4.089; p < 0.001).
Conclusions Ergonovine echocardiography for coronary vasospasm diagnosis could be safely performed even without angiographic documentation of fixed coronary stenosis depending on the clinical presentation, and provided important prognostic implication. Ergonovine echocardiography can replace the invasive spasm provocation testing, which has been overlooked unfairly.
↵∗ Drs. Om, Yoo, and Cho contributed equally to this work and are co-first authors.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received December 28, 2019.
- Revision received March 3, 2020.
- Accepted March 5, 2020.
- 2020 American College of Cardiology Foundation
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