Abnormal coronary reserve and left ventricular wall motion during cold pressor test in patients with previous left ventricular ballooning syndrome

Giuseppe Barletta, Stefano Del Pace, Maria Boddi, Riccarda Del Bene, Claudia Salvadori, Benedetta Bellandi, Mirella Coppo, Elisa Saletti, Gian Franco Gensini

Research output: Contribution to journalArticle

Abstract

Aims: To investigate whether and how cold pressor test (CPT) could affect myocardial perfusion and left ventricular (LV) function in patients with previous LV ballooning syndrome (LVBS).Methods and resultsCold pressor test (3 min hand immersion in ice-water) was performed in 17 women with previous LVBS and in 7 age-and risk factor-matched women with chest pain and normal coronary arteries. At baseline and peak CPT, global and regional LV function, and myocardial perfusion were quantitatively assessed by real-time three-dimensional echocardiography (RT3DE) and myocardial contrast (SonoVue, Bracco) 2D echocardiography (MCE), respectively (Philips iE33 machine, X3-1 and S5-1 probes). Data were analysed off-line (QLab 6.0 software). Peripheral venous catecholamines were assayed by high performance liquid chromatography with electrochemical detection. Cold pressor test induced similar haemodynamic changes and catecholamine increase in controls and LVBS patients. Left ventricular ejection fraction decreased and transient new mid-ventricular and apical motion abnormalities developed in LVBS patients only (quantitative RT3D analysis), without corresponding perfusion defects (MCE). At peak CPT, coronary blood flow and velocity increased (quantitative MCE analysis) in control subjects only.ConclusionCold pressor test induced LV wall motion abnormalities unmatched to regional coronary flow reduction in LVBS patients only. The reduced coronary reserve in response to CPT suggests microvascular dysfunction in LVBS patients.

Original languageEnglish
Pages (from-to)3007-3014
Number of pages8
JournalEuropean Heart Journal
Volume30
Issue number24
DOIs
Publication statusPublished - Dec 2009

Keywords

  • Cold pressor test
  • Coronary flow
  • Echocardiography
  • Tako-Tsubo

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Barletta, G., Del Pace, S., Boddi, M., Del Bene, R., Salvadori, C., Bellandi, B., Coppo, M., Saletti, E., & Gensini, G. F. (2009). Abnormal coronary reserve and left ventricular wall motion during cold pressor test in patients with previous left ventricular ballooning syndrome. European Heart Journal, 30(24), 3007-3014. https://doi.org/10.1093/eurheartj/ehp325