Values of intravenous ergonovine test with two-dimensional echocardiography for diagnosis of coronary artery spasm.

The purpose of this study was to evaluate the clinical validity of the bedside ergonovine test with digital echocardiography and the side-by-side continuous cineloop display method (ergonovine echocardiography) as a noninvasive diagnostic tool for coronary artery spasm. Bedside ergonovine test was performed in 66 patients who showed coronary vasospasm during coronary angiography including provocation testing (group with variant angina) and 39 patients with normal angiograms and no evidence of coronary artery spasm (group with nonanginal pain). A bolus of ergonovine maleate (0.025 or 0.05 mg) was injected at 5-minute intervals up to total cumulative dosage of 0.35 mg, and 12-lead electrocardiography and two-dimensional echocardiography were recorded every 3 minutes after each injection. Left ventricular wall motion was analyzed with a commercially available quad system. The positive criteria of bedside ergonovine test included reversible ST segment elevation or depression on electrocardiograms (ECG criteria) and reversible regional wall motion abnormalities by echocardiography (Echo criteria). The overall sensitivity and specificity of ECG criteria were 53% (35/66; 95% confidence interval 41% to 65%) and 100%, respectively. By Echo criteria the sensitivity increased to 89% (59/66; 95% confidence interval 81% to 97%), with a specificity of 95% (37/39).(ABSTRACT TRUNCATED AT 250 WORDS)

Immediate and one-year results of percutaneous mitral balloon valvuloplasty using Inoue and double-balloon techniques.

Many investigators have reported the results of percutaneous mitral valvuloplasty (PMV) using the Inoue or double-balloon technique, but to date, the immediate and long-term follow-up results of the 2 different procedures have not been compared in a prospective study. Therefore, a prospective, randomized trial was performed in 120 consecutive patients who underwent PMV using Inoue (n = 59; group I) or double (n = 61; group D) balloons. The success rate was 83% in group I, and 89% in group D. The magnitude of changes in mitral valve area and hemodynamic variables was the same in both groups. Immediately after dilation, the long diameter changes of the mitral orifice was greater in group D, and the increase in ejection fraction slope was significantly greater in group D. The duration of the total procedure, and the fluoroscopic time was significantly shorter in group I. The incidence of left-to-right shunt at the atrial level (Qp/Qs > 1.5) was 3.4% in group I and 4.9% in group D. Severe mitral regurgitation (grade > or = 3) occurred in 2 patients in each group. At follow-up, the mitral valve area had significantly decreased at 6 months, but no further changes occurred at 1-year follow-up in both groups. The long diameter of the mitral orifice was greater in group D until 6 months after PMV, but the difference was not apparent at 1-year follow-up. In conclusion, the Inoue and double-balloon techniques obtained equivalent results in the success rate and frequency of complications.(ABSTRACT TRUNCATED AT 250 WORDS)