BACKGROUND: Coronary atherosclerosis with inflammation gives rise to coronary vasospasm in the patients with coronary vasospastic angina. We have postulated that the peripheral leukocyte count and the differential count are associated with vasospastic angina. METHODS: 144 patients who underwent intracoronary ergonovine provocation testing between January 2002 and December 2004 were divided into two groups: Group I (72 patients with provoked spasm, mean age: 54.8+/-10.7 years, males: 75%) and Group II (72 without spasm, mean age: 55.3+/-10.2 years, males: 35%). Blood sampling was done to measure the lipid profiles and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) levels and the monocyte counts. We compared the angiographic findings and laboratory data between the two groups. RESULTS: There were no significant differences in the levels of serum lipid and hsCRP between the two groups. The white blood cell count and the monocyte count were higher in Group I than with Group II (7496.4+/-2622.28 vs. 6703.2+/-1768.37/mm3, respectively, p=0.035; 627.5+/-270.70 vs. 426.9+/-205.76/mm3, respectively, p<0.001). Gensini's score was higher in Group I than in Group II (2.2+/-2.88 vs. 0.5+/-1.03, respectively, p<0.001). Multivariate analysis showed that the monocyte count and Gensini's score were independent factors affecting coronary spasm (p=0.047 and p=0.018, respectively). According to a receiver operating characteristics curve analysis, the area under the curve of the monocyte count was 0.738, that of the neutrophil count was 0.577 and that of the WBC count was 0.572. The cut-off value of the monocyte count was 530/mm3; the sensitivity and specificity of this cut-off value were 64% and 76%, respectively. CONCLUSIONS: The peripheral monocyte count is an independent marker for predicting vasospastic angina in the patients with resting chest pain and insignificant coronary artery stenosis.
Multivariate Analysis ; *Monocytes ; Middle Aged ; Male ; *Leukocyte Count ; Humans ; Female ; Coronary Vasospasm/*blood/diagnosis ; Coronary Stenosis/*blood ; Chest Pain/*blood ; C-Reactive Protein/analysis ; Biological Markers ; Aged ; Adult

Establishment of a noninvasive diagnostic method to document coronary vasospasm would be useful in the management of the patients with variant angina, especially in the screening of the patients, evaluation of the therapeutic efficacy of the prescribed drugs and determination of the activity of the disease. The present study was performed to clarify the clinical feasibility and diagnostic validity of bedside intravenous ergonovine test and to determine the variables affecting the diagnostic sensitivity of the test. The study group consisted of 59 patients with chest pain in whom diagnostic coronary angiography with intracoronary acetylcholine challenge test for the induction of coronary vasospasm was performed ; 30 patients were proven to have variant angina and 29 patients to have atypical chest pain. Bedside ergonovine test was done one day after the diagnostic coronary angiography and reversible ST segment displacement(elevation or depression) and/or T wave changes in ECG with ergonovine injection was used as the only positive criteria of the test. A bolus of ergonovine maleate(0.025 or 0.050mg) was injected intravenously at 5 minute intervals up to total cumulative dosage of 0.25 mg, and blood pressure and a 12-lead ECG were recorded every 3 minutes after each injection. Intravenous nitroglycerin of 0.25mg was administered for the termination of the test when hypertension(systolic BP>200mmHg), hypotension(systolic BP<90mmHg) or significant arrhythmia was observed. Twenty seven out of 30 patients with variant angina developed chest pain or discomport during the test and among them 22 showed simultaneous reversible ECG changes. In 29 patients with atypical chest pain 11 patients(38%) complained of chest pain or discomport without reversible ECG change during the test, and the overall sensitivity and specificity of the beside ergonovine test were 73% and 100% respectively. The mean cumulative dose of ergonovine which evoked the positive reponse was 117microgram. The patterns of reversible ECG changes of the positive response were variable : 50%(11/22) showed significant ST segment elevation, while ST segment depression(18%) and T wave changes without ST segment displacement(32%) were observed with ergonovine injection. Degree of disease activity of the variant angina, number of spasm-induced vessels and presence of concomitant fixed lesion are important variables affecting the sensitivity of the test. The changes of blood pressure and heart rate were minimal during the test and there was neither significant arrhythmia nor test-related mortality. Thus we concluded that bedside intravenous ergonovine test is a safe, sensitive and highly specific test for coronary vasospasm in selected group of patients with chest pain syndrome. Further study with other methods besides ECG to document myocardial ischemia seems to be necessary for improvement of the sensitivity of bedside ergonovine test.
Acetylcholine ; Arrhythmias, Cardiac ; Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Vasospasm ; Diagnosis* ; Electrocardiography ; Ergonovine* ; Heart Rate ; Humans ; Mass Screening ; Mortality ; Myocardial Ischemia ; Nitroglycerin ; Sensitivity and Specificity