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To evaluate the prevalence of dobutamine-induced coronary spasm in patients without known coronary artery disease (CAD), to determine the potential predictors of spasm amongst those with positive dobutamine stress echocardiography (DSE) and to assess mid-term clinical outcomes.
3952 patients referred to our echocardiography laboratory for DSE between January 2010 and May 2012 were prospectively investigated. Those with positive DSE underwent coronary angiograms with systematic methylergometrine intracoronary injection in case of absence of significant coronary stenosis or spontaneous occlusive coronary spasm. Patients with spontaneous occlusive coronary spasm or positive methylergometrine test but no significant stenoses were enrolled and compared with those with positive DSE and significant coronary lesions at angiograms but no history of CAD.
29 patients with DSE-related vasospasm (19.4% of positive DSE without known CAD) were compared with 64 patients with significant coronary lesions. They were significantly younger (56 vs 67.7 years; p<0.001), had less frequently hypertension (27.6% vs 64.1%; p=0.01) and diabetes mellitus (31% vs 68.8%; p=0.01); conversely they had more frequently dyslipidemia (79.3% vs 53.1%;p=0.021); they also had a lower ischemic area at peak DSE (<4 involved segments) at 79.3% vs 48.4% (p=0.006). On multivariate analysis, dyslipidemia (HR=21.3; 95% CI= [3.45-131.7]; p=0.001), and less than 4 ischemic segments at peak DSE (HR=4.3; 95% CI= [1.14-16.23]; p=0.034) were found to be independant predictors of coronary spasm rather than significant coronary lesions. Conversely; hypertension, DM and age>60 were predictors of significant coronary lesions rather than spam. Long-term actuarial survival free from adverse events was significantly higher in the group of patients with coronary spasm at 91% versus 67% (log rank p= 0.027) in patients with significant coronary disease.
DSE- induced coronary spasm is an important condition associated with a good mid-term prognosis; dyslipidemia and lower ischemic area at peak DSE predicted spasm rather than significant stenoses in patients with positive DSE and no history of CAD.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: Echocardiographic Imaging of Patients with CAD: I
Abstract Category: 18. Imaging: Echo
Presentation Number: 1267-324
- 2013 American College of Cardiology Foundation