Regional coronary hemodynamic effects of ergonovine in patients with and without variant angina.

Abstract

To define more completely the regional coronary hemodynamic significance of ergonovine-provoked coronary angiographic responses, coronary sinus flow (CSF), great cardiac vein flow (GCVF), aortic and left ventricular pressures and coronary artery diameters were measured before and after ergonovine administration in 13 patients with variant angina (VA) and 19 patients without VA. After ergonovine a major diameter reduction occurred in the left coronary artery of 10 patients with VA and in the right coronary artery of 2 of these patients. In 3 other patients with VA a major diameter reduction occurred only in the right coronary artery. All 13 patients with VA developed angina and 12 had ST-segment shifts. In patients with VA and a major left coronary artery dimaeter reduction CSF and GCVF decreased (31 and 30%, respectively) as total and anterior regional coronary resistance increased (47 and 46%, respectively) (all P < 0.01). In the 3 patients with VA who developed only right coronary artery diameter reduction, CSF decreased in one and was unchanged in 2; GCVF was unchanged in all. In patients without VA, ergonovine induced only minor coronary artery diameter reduction (15%); none had ST-segment shifts, and 4 had chest pain. CSF and GCVF increased minimally (14%) as total and anterior regional coronary resistance decreased slightly (5 and 11%, respectively) (all P < 0.01). Ergonovine-induced major diameter reduction of the left coronary artery evidently reduces total and anterior regional left ventricular flow and evokes a significant decrease in myocardial O2 delivery in certain patients with VA coincident with angina and ST-segment shifts.