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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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 -

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

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