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Gurgoglione FL, Vignali L, Montone RA, Rinaldi R, Benatti G, Solinas E, Leone AM, Galante D, Campo G, Biscaglia S, Porto I, Benenati S, Niccoli G. Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders. Life (Basel) 2024; 14:292. [PMID: 38541619 PMCID: PMC10970947 DOI: 10.3390/life14030292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 11/11/2024] Open
Abstract
Coronary vasomotor disorders (CVD) are characterized by transient hypercontraction of coronary vascular smooth muscle cells, leading to hypercontraction of epicardial and/or microvascular coronary circulation. CVDs play a relevant role in the pathogenesis of ischemia, angina and myocardial infarction with non-obstructive coronary arteries. Invasive provocative testing with intracoronary Acetylcholine (ACh) administration is the gold standard tool for addressing CVD, providing relevant therapeutic and prognostic implications. However, safety concerns preclude the widespread incorporation of the ACh test into clinical practice. The purpose of this review is to shed light on the pathophysiology underlying CVD and on the clinical role of the ACh test, focusing on safety profile and prognostic implications. We will also discuss contemporary evidence on the management of CVD and the role of the ACh test in driving a personalized approach of patients with CVD.
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Affiliation(s)
| | - Luigi Vignali
- Division of Cardiology, Parma University Hospital, 43126 Parma, Italy; (L.V.); (G.B.); (E.S.)
| | - Rocco Antonio Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Giorgio Benatti
- Division of Cardiology, Parma University Hospital, 43126 Parma, Italy; (L.V.); (G.B.); (E.S.)
| | - Emilia Solinas
- Division of Cardiology, Parma University Hospital, 43126 Parma, Italy; (L.V.); (G.B.); (E.S.)
| | - Antonio Maria Leone
- Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina, Gemelli Isola Roma, 00186 Rome, Italy; (A.M.L.); (D.G.)
| | - Domenico Galante
- Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina, Gemelli Isola Roma, 00186 Rome, Italy; (A.M.L.); (D.G.)
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy; (G.C.); (S.B.)
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, 44124 Ferrara, Italy; (G.C.); (S.B.)
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, 16126 Genoa, Italy; (I.P.); (S.B.)
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino—Italian IRCCS Cardiology Network, 16126 Genoa, Italy
| | - Stefano Benenati
- Department of Internal Medicine, University of Genoa, 16126 Genoa, Italy; (I.P.); (S.B.)
| | - Giampaolo Niccoli
- Division of Cardiology, Parma University Hospital, University of Parma, 43126 Parma, Italy;
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Feyz L, Nannan Panday R, Henneman M, Verzijlbergen F, Constantinescu AA, van Dalen BM, Brugts JJ, Caliskan K, Geleijnse ML, Kardys I, Van Mieghem NM, Manintveld O, Daemen J. Endovascular renal sympathetic denervation to improve heart failure with reduced ejection fraction: the IMPROVE-HF-I study. Neth Heart J 2021; 30:149-159. [PMID: 34609726 PMCID: PMC8881518 DOI: 10.1007/s12471-021-01633-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The aim of the present study was to assess the safety and efficacy of renal sympathetic denervation (RDN) in patients with heart failure with reduced ejection fraction (HFrEF). Methods We randomly assigned 50 patients with a left ventricular ejection fraction (LVEF) ≤ 35% and NYHA class ≥ II, in a 1:1 ratio, to either RDN and optimal medical therapy (OMT) or OMT alone. The primary safety endpoint was the occurrence of a combined endpoint of cardiovascular death, rehospitalisation for heart failure, and acute kidney injury at 6 months. The primary efficacy endpoint was the change in iodine-123 meta-iodobenzylguanidine (123I‑MIBG) heart-to-mediastinum ratio (HMR) at 6 months. Results Mean age was 60 ± 9 years, 86% was male and mean LVEF was 33 ± 8%. At 6 months, the primary safety endpoint occurred in 8.3% vs 8.0% in the RDN and OMT groups, respectively (p = 0.97). At 6 months, the mean change in late HMR was −0.02 (95% CI: −0.08 to 0.12) in the RDN group, versus −0.02 (95% CI: −0.09 to 0.12) in the OMT group (p = 0.95) whereas the mean change in washout rate was 2.34 (95% CI: −6.35 to 1.67) in the RDN group versus −2.59 (95% CI: −1.61 to 6.79) in the OMT group (p-value 0.09). Conclusion RDN with the Vessix system in patients with HFrEF was safe, but did not result in significant changes in cardiac sympathetic nerve activity at 6 months as measured using 123I‑MIBG. Supplementary Information The online version of this article (10.1007/s12471-021-01633-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Feyz
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - R Nannan Panday
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - M Henneman
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - F Verzijlbergen
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A Constantinescu
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - B M van Dalen
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - J J Brugts
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - K Caliskan
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - M L Geleijnse
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - I Kardys
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - N M Van Mieghem
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - O Manintveld
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - J Daemen
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
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Travin MI. Expanding the clinical potential of cardiac radionuclide adrenergic imaging. J Nucl Cardiol 2020; 27:2210-2215. [PMID: 30761479 DOI: 10.1007/s12350-019-01629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Mark I Travin
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY, 10467-2490, USA.
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