Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine

Rutger G T Feenstra; Coen K M Boerhout; Caitlin E M Vink; Janneke Woudstra; Marianne E Wittekoek; Guus A de Waard; Yolande Appelman; Etto C Eringa; Koen M J Marques; Robbert J de Winter; Tim P van de Hoef; Marcel A M Beijk; Jan J Piek

doi:10.1016/j.ijcha.2022.101105

Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine

Rutger G T Feenstra, Coen K M Boerhout, Caitlin E M Vink, Janneke Woudstra, Marianne E Wittekoek, Guus A de Waard, Yolande Appelman, Etto C Eringa, Koen M J Marques, Robbert J de Winter, Tim P van de Hoef, Marcel A M Beijk, Jan J Piek^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Vasoreactivity testing with high-dose acetylcholine is considered vasospasm provocation and low-dose as endothelial function testing.

AIMS: To assess the changes in reaction to low- and high-dose acetylcholine in the endotypes of CAS as defined by the Coronary Vasomotor Disorders International Study Group (COVADIS) working group.

METHODS: Changes in coronary epicardial diameter, coronary blood flow (CBF) and vascular resistance were determined at low-dose acetylcholine.

RESULTS: A total of 88 ANOCA patients were included in this analysis. In the negative group (n = 14) incremental infusion of acetylcholine produced a progressive increase in CBF (p = 0.008). In reaction to low-dose acetylcholine, the epicardial vasospasm group (n = 30) is characterised by epicardial vasoconstriction that is significantly more severe compared to the microvascular vasospasm group (p = 0.004)(n = 23). The equivocal group (n = 21) is characterised by an increase in CBF and reduction in vascular resistance that are both significantly different compared to the epicardial vasospasm group (p = 0.036 and p = 0.007, respectively). High-dose acetylcholine decreased epicardial diameter and CBF significantly in the epicardial vasospasm, microvascular vasospasm and in the equivocal group (all p < 0.05. Vascular resistance increased significantly in the epicardial vasospasm group (p < 0.001) and equivocal group (p = 0.009).

CONCLUSION: In reaction to low-dose acetylcholine the negative and equivocal endotype has haemodynamic changes that suggest intact endothelium. In reaction to high-dose acetylcholine the epicardial vasospasm, microvascular vasospasm and equivocal endotype have hemodynamic changes that suggest VSMC-hyperreactivity. These results suggest that the equivocal endotype is a positive test comparable to microvascular vasospasm in the presence of normal endothelial function.

Original language	English
Article number	101105
Number of pages	8
Journal	IJC Heart and Vasculature
Volume	42
DOIs	https://doi.org/10.1016/j.ijcha.2022.101105
Publication status	Published - Oct 2022

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Cite this

Feenstra, R. G. T., Boerhout, C. K. M., Vink, C. E. M., Woudstra, J., Wittekoek, M. E., de Waard, G. A., Appelman, Y., Eringa, E. C., Marques, K. M. J., de Winter, R. J., van de Hoef, T. P., Beijk, M. A. M., & Piek, J. J. (2022). Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine. IJC Heart and Vasculature, 42, Article 101105. https://doi.org/10.1016/j.ijcha.2022.101105

@article{39016e1952bc4623ac5778e7f956789c,

title = "Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine",

abstract = "BACKGROUND: Vasoreactivity testing with high-dose acetylcholine is considered vasospasm provocation and low-dose as endothelial function testing.AIMS: To assess the changes in reaction to low- and high-dose acetylcholine in the endotypes of CAS as defined by the Coronary Vasomotor Disorders International Study Group (COVADIS) working group.METHODS: Changes in coronary epicardial diameter, coronary blood flow (CBF) and vascular resistance were determined at low-dose acetylcholine.RESULTS: A total of 88 ANOCA patients were included in this analysis. In the negative group (n = 14) incremental infusion of acetylcholine produced a progressive increase in CBF (p = 0.008). In reaction to low-dose acetylcholine, the epicardial vasospasm group (n = 30) is characterised by epicardial vasoconstriction that is significantly more severe compared to the microvascular vasospasm group (p = 0.004)(n = 23). The equivocal group (n = 21) is characterised by an increase in CBF and reduction in vascular resistance that are both significantly different compared to the epicardial vasospasm group (p = 0.036 and p = 0.007, respectively). High-dose acetylcholine decreased epicardial diameter and CBF significantly in the epicardial vasospasm, microvascular vasospasm and in the equivocal group (all p < 0.05. Vascular resistance increased significantly in the epicardial vasospasm group (p < 0.001) and equivocal group (p = 0.009).CONCLUSION: In reaction to low-dose acetylcholine the negative and equivocal endotype has haemodynamic changes that suggest intact endothelium. In reaction to high-dose acetylcholine the epicardial vasospasm, microvascular vasospasm and equivocal endotype have hemodynamic changes that suggest VSMC-hyperreactivity. These results suggest that the equivocal endotype is a positive test comparable to microvascular vasospasm in the presence of normal endothelial function.",

author = "Feenstra, {Rutger G T} and Boerhout, {Coen K M} and Vink, {Caitlin E M} and Janneke Woudstra and Wittekoek, {Marianne E} and {de Waard}, {Guus A} and Yolande Appelman and Eringa, {Etto C} and Marques, {Koen M J} and {de Winter}, {Robbert J} and {van de Hoef}, {Tim P} and Beijk, {Marcel A M} and Piek, {Jan J}",

note = "{\textcopyright} 2022 The Authors. Published by Elsevier B.V.",

year = "2022",

month = oct,

doi = "10.1016/j.ijcha.2022.101105",

language = "English",

volume = "42",

journal = "IJC Heart and Vasculature",

issn = "2352-9067",

publisher = "Elsevier",

}

Feenstra, RGT, Boerhout, CKM, Vink, CEM, Woudstra, J, Wittekoek, ME, de Waard, GA, Appelman, Y, Eringa, EC, Marques, KMJ, de Winter, RJ, van de Hoef, TP, Beijk, MAM & Piek, JJ 2022, 'Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine', IJC Heart and Vasculature, vol. 42, 101105. https://doi.org/10.1016/j.ijcha.2022.101105

TY - JOUR

T1 - Haemodynamic characterisation of different endotypes in coronary artery vasospasm in reaction to acetylcholine

AU - Feenstra, Rutger G T

AU - Boerhout, Coen K M

AU - Vink, Caitlin E M

AU - Woudstra, Janneke

AU - Wittekoek, Marianne E

AU - de Waard, Guus A

AU - Appelman, Yolande

AU - Eringa, Etto C

AU - Marques, Koen M J

AU - de Winter, Robbert J

AU - van de Hoef, Tim P

AU - Beijk, Marcel A M

AU - Piek, Jan J

PY - 2022/10

Y1 - 2022/10

N2 - BACKGROUND: Vasoreactivity testing with high-dose acetylcholine is considered vasospasm provocation and low-dose as endothelial function testing.AIMS: To assess the changes in reaction to low- and high-dose acetylcholine in the endotypes of CAS as defined by the Coronary Vasomotor Disorders International Study Group (COVADIS) working group.METHODS: Changes in coronary epicardial diameter, coronary blood flow (CBF) and vascular resistance were determined at low-dose acetylcholine.RESULTS: A total of 88 ANOCA patients were included in this analysis. In the negative group (n = 14) incremental infusion of acetylcholine produced a progressive increase in CBF (p = 0.008). In reaction to low-dose acetylcholine, the epicardial vasospasm group (n = 30) is characterised by epicardial vasoconstriction that is significantly more severe compared to the microvascular vasospasm group (p = 0.004)(n = 23). The equivocal group (n = 21) is characterised by an increase in CBF and reduction in vascular resistance that are both significantly different compared to the epicardial vasospasm group (p = 0.036 and p = 0.007, respectively). High-dose acetylcholine decreased epicardial diameter and CBF significantly in the epicardial vasospasm, microvascular vasospasm and in the equivocal group (all p < 0.05. Vascular resistance increased significantly in the epicardial vasospasm group (p < 0.001) and equivocal group (p = 0.009).CONCLUSION: In reaction to low-dose acetylcholine the negative and equivocal endotype has haemodynamic changes that suggest intact endothelium. In reaction to high-dose acetylcholine the epicardial vasospasm, microvascular vasospasm and equivocal endotype have hemodynamic changes that suggest VSMC-hyperreactivity. These results suggest that the equivocal endotype is a positive test comparable to microvascular vasospasm in the presence of normal endothelial function.

AB - BACKGROUND: Vasoreactivity testing with high-dose acetylcholine is considered vasospasm provocation and low-dose as endothelial function testing.AIMS: To assess the changes in reaction to low- and high-dose acetylcholine in the endotypes of CAS as defined by the Coronary Vasomotor Disorders International Study Group (COVADIS) working group.METHODS: Changes in coronary epicardial diameter, coronary blood flow (CBF) and vascular resistance were determined at low-dose acetylcholine.RESULTS: A total of 88 ANOCA patients were included in this analysis. In the negative group (n = 14) incremental infusion of acetylcholine produced a progressive increase in CBF (p = 0.008). In reaction to low-dose acetylcholine, the epicardial vasospasm group (n = 30) is characterised by epicardial vasoconstriction that is significantly more severe compared to the microvascular vasospasm group (p = 0.004)(n = 23). The equivocal group (n = 21) is characterised by an increase in CBF and reduction in vascular resistance that are both significantly different compared to the epicardial vasospasm group (p = 0.036 and p = 0.007, respectively). High-dose acetylcholine decreased epicardial diameter and CBF significantly in the epicardial vasospasm, microvascular vasospasm and in the equivocal group (all p < 0.05. Vascular resistance increased significantly in the epicardial vasospasm group (p < 0.001) and equivocal group (p = 0.009).CONCLUSION: In reaction to low-dose acetylcholine the negative and equivocal endotype has haemodynamic changes that suggest intact endothelium. In reaction to high-dose acetylcholine the epicardial vasospasm, microvascular vasospasm and equivocal endotype have hemodynamic changes that suggest VSMC-hyperreactivity. These results suggest that the equivocal endotype is a positive test comparable to microvascular vasospasm in the presence of normal endothelial function.

U2 - 10.1016/j.ijcha.2022.101105

DO - 10.1016/j.ijcha.2022.101105

M3 - Article

C2 - 36017267

SN - 2352-9067

VL - 42

JO - IJC Heart and Vasculature

JF - IJC Heart and Vasculature

M1 - 101105

ER -