Chahine R A
Cardiol Clin. 1985 Feb;3(1):19-28.
Coronary artery spasm can now be well documented in the cardiac catheterization laboratory. At present, reliable criteria are available for the diagnosis of severe episodes that are characteristic of patients with Prinzmetal's variant angina. Newer criteria for the diagnosis of milder episodes of spasm are gradually being developed. Optimal criteria may become available with further progress of quantitative angiography. Provocation techniques for the induction of an attack of spasm in the cardiac catheterization laboratory are widely available. Of these, ergonovine testing is the most popular. The tests can usually be performed by experienced angiographers with impressive safety and provide a high degree of sensitivity and specificity when used in patients with the clinical diagnosis of variant angina. Although the research applications of such techniques are extremely broad, their practical clinical indications are somewhat limited to the work-up of patients with infrequent chest pains and normal or near-normal coronary arteriograms. There are other indirect methods for the diagnosis of coronary spasm, but the ideal technique is not available yet. Further expansion of newer modalities for the diagnosis of coronary artery spasm will certainly enhance our understanding of myocardial ischemia and will improve our ability to manage patients with ischemic heart disease.
冠状动脉痉挛现在在心脏导管实验室中能够得到很好的记录。目前，对于诊断严重发作（即变异型心绞痛患者的特征性发作）已有可靠的标准。诊断较轻发作痉挛的更新标准也在逐步制定。随着定量血管造影技术的进一步发展，可能会出现最佳标准。在心脏导管实验室中用于诱发痉挛发作的激发技术广泛可用。其中，麦角新碱试验最为常用。这些试验通常可由经验丰富的血管造影师进行，安全性令人印象深刻，用于临床诊断为变异型心绞痛的患者时，具有高度的敏感性和特异性。尽管此类技术的研究应用极为广泛，但其实际临床适应证在一定程度上仅限于对胸痛发作不频繁且冠状动脉造影正常或接近正常的患者进行检查。还有其他诊断冠状动脉痉挛的间接方法，但尚未有理想的技术。进一步拓展诊断冠状动脉痉挛的新方法必将增进我们对心肌缺血的理解，并提高我们管理缺血性心脏病患者的能力。
