Without Variant Angina

To define more completely the regional coronary hemodynamic significance of ergonovineprovoked coronary angiographic responses, we measured coronary sinus flow (CSF) and great cardiac vein flow (GCVF) aortic and left ventricular pressures, and coronary artery diameters 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 also in the right coronary artery of two of these patients. In three 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 diameter reduction, both 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 three patients with VA who developed only right coronary artery diameter reduction, CSF decreased in one and was unchanged in two; GCVF was unchanged in all. In patients without VA, ergonovine induced only minor coronary artery diameter reduction (15%); none had ST-segment shifts, and four had chest pain. Both CSF and GCVF increased minimally (14%) as total and anterior regional coronary resistance decreased slightly (5% and 11%, respectively) (all p < 0.01). These data provide evidence that ergonovine-induced major diameter reduction of the left coronary artery reduces total and anterior regional left ventricular flow. These results support the concept that ergonovine evokes a significant decrease in myocardial oxygen delivery in certain patients with VA coincident with angina and ST-segment shifts.