Summary
This study describes the quantitative coronary angiographic response to one minute hand immersion in ice water, the cold pressor test (CPT). The study population consisted of 20 patients with insignificant coronary disease (>50% diameter narrowing), 26 patients with exertional angina and 18 patients with angina at rest. A total of 49 obstructive lesions and 203 nonobstructed segments in the left coronary arterial system were analyzed with the CAAS.
Overall, CPT decreased the mean diameters of nonobstructed coronary segments from 2.76 to 2.68mm (−3%, p>0.001). Relative changes in mean coronary arterial dimensions were similar among the three groups of patients. The diameter of the left main artery was not influenced by CPT. The relative magnitude of change by CPT was greatest (−6%) in the distal segments of the circumflex artery.
The overall size of stenotic arterial segments demonstrated comparable vaso-constriction (−3%) as nonobstructed coronary segments. Focal spasm was not observed after CPT. Increases in percentages luminal narrowing at stenotic lesions never exceeded 25%. At the average, the minimal obstruction diameter increased slightly, but not significantly after CPT (1.47 vs 1.52mm, n.s.).
The results from this study thus indicate that CPT may not be a reliable provocative manoeuvre to induce focal coronary spasm.
This study was supported by the Dutch Heart Foundation under grant no. 82.058
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Epstein SE, Stampfer M, Beiser GD, Goldstein RE, Braunwald E: Effects of a reduction in environmental temperature on the circulatory response to exercise in man. Implications concerning angina pectoris. N Engl J Med 280: 7–11, 1969
Neill WA, Duncan DA, Kloster F, Mahler DJ: Response of coronary circulation to cutaneous cold. Am J Med 56: 471–476, 1974
Lassvik C, Areskog N-H: Angina pectoris during inhalation of cold air. Reactions to exercise. Br Heart J 43: 661–667, 1980
Hattenhauer M, Neill WA: The effect of cold air inhalation on angina pectoris and myocardial oxygen supply. Circulation 51: 1053–1058, 1975
Mudge GH Jr, Grossman W, Mills RM Jr, Lesch M, Braunwald E. Reflex increase in coronary vascular resistance in patients with ischemic heart disease. N Engl J Med 295: 1333–1337, 1976
Raizner AE, Chahine RA, Ishimori T, Verani MS, Zacca N, Jamal N, Miller RR, Luchi RJ: Provocation of coronary artery spasm by the cold pressor test. Hemodynamic, artériographie and quantitative angiographic observations. Circulation 62: 925–932, 1980.
Rasmussen K, Bagger JP, Bottzauw J, Henningsen P: Prevalence of vasospastic ischaemia induced by the cold pressor test or hyperventilation in patients with severe angina. Eur Heart J 5: 354–361, 1984.
Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LSC, McGoon DC, Murphy ML, Roe BB: A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51: 7–40, 1975
Chahine RA: Prinzmetal’s variant angina. A syndrome apart or another clinical presentation of atheromatous heart disease. Arch Intern Med 139: 26–27, 1979
Maseri A, Severi S, de Nes M, l’Abbate A, Chierchia S, Marzilli M, Ballestra AM, Parodi O, Biagini A, Distante A: ‘Variant’ angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am J Card 42: 1019–1035, 1978
Maseri A, l’Abbate A, Chierehia S, Parodi 0, Severi S, Biagini A, Distante A, Marzilli M, Ballestra AM: Significance of spasm in the pathogenesis of ischemic heart disease. Am J Card 44: 788–792, 1979
Oliva PB, Breckinridge JC: Arteriographic evidence of coronary arterial spasm in acute myocardial infarction. Circulation 56: 366–374, 1977
Maseri A, l’Abbate A, Baroldi G, Chierehia S, Marzilli M, Ballestra AM, Severi S, Parodi O, Biagini A, Distante A, Pesola A: Coronary vasospasm as a possible cause of myocardial infarction. A conclusion derived from the study of ‘preinfarction’ angina. N Engl J Med 299: 1271–1277, 1978
Bertrand ME, LaBlanche JM, Tilmant PY, Thieuleux FA, Delforge MR, Carre AG, Asseman P, Berzin B, Libersa C, Laurent JM: Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography. Circulation 65: 1299–1306, 1982
Bauman D: Complications after provocation of coronary spasm with ergonovine maleate. Am J Cardiol 42: 694–695, 1978
Kelley KO, Feigl EO: Segmental a-receptor-mediated vasoconstriction in the canine coronary circulation. Circ Res 43: 908–917, 1978
Feldman RL, Curry RC Jr, Pepine CJ, Mehta J, Conti CR: Regional coronary hemodynamic effects of ergonovine in patients with and without variant angina. Circulation 62: 149–159, 1980
Feldman RL, Whittle JL, Marx JD, Pepine CJ, Conti CR: Regional coronary hemodynamic responses to cold stimulation in patients without variant angina. Am J Cardiol 49: 665–673, 1982
Guiomard A, Zygelman M, Evstigneff T, Bréaud N, Roland E, Pansard Y, Mérillon JP, Gourgon R: Effets hémodynamiques et métaboliques coronaires du test au froid avant et après acébutolol. Arch Mal Coeur 76: 77–85, 1983
Feldman RL, Whittle JL, Pepine CJ, Conti CR: Regional coronary angiographic observations during cold stimulation in patients with exertional chest pain: Comparison of diameter responses in normal and fixed stenotic vessels. Am Heart J 102: 822–830, 1981
Wendt Th, Schutz W, Kaltenbach M, Kober G: Auswirkung von Kältereizen auf Hämodynamik und Koronargefässweite. Provokation von Koronarspasmen. Z Kardiol 72: 24–31, 1983
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 1986 Martinus Nijhoff Publisher, Dordrecht
About this chapter
Cite this chapter
Reiber, J.H.C., Serruys, P.W., Slager, C.J. (1986). Responses of normal and obstructed coronary arterial segments to cold stimulation; a quantitative angiographic study. In: Quantitative Coronary and Left Ventricular Cineangiography. Developments in Cardiovascular Medicine, vol 51. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4239-4_20
Download citation
DOI: https://doi.org/10.1007/978-94-009-4239-4_20
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-010-8382-9
Online ISBN: 978-94-009-4239-4
eBook Packages: Springer Book Archive