ArticleCirculation. Cardiovascular interventions2020
Dose-Response Relationship Between Intracoronary Acetylcholine and Minimal Lumen Diameter in Coronary Endothelial Function Testing of Women and Men With Angina and No Obstructive Coronary Artery Disease.
Article in Circulation. Cardiovascular interventions, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00823563 (Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease), which is not on this map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Prevalence of Coronary Microvascular Disease and Coronary Vasospasm in Patients With Nonobstructive Coronary Artery Disease: Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2022Pooled it
- Intracoronary acetylcholine for vasospasm provocation in women with ischemia and no obstructive coronary artery disease.American heart journal plus : cardiology research and practice · 2025Article
- Noninvasive Assessment of Vascular Function: From Physiological Tests to Biomarkers.JACC. Asia · 2024Review
- Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders.Life (Basel, Switzerland) · 2024Review
- Muscarinic control of cardiovascular function in humans: a review of current clinical evidence.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2024Review
- The Need for Separate Testing with Acetylcholine for the Assessment of Endothelial Dysfunction and Coronary Artery Spasm.European cardiology · 2024Review
- Evaluation of Ischemia with No Obstructive Coronary Arteries (INOCA) and Contemporary Applications of Cardiac Magnetic Resonance (CMR).Medicina (Kaunas, Lithuania) · 2023Review
- Invasive Evaluation for Coronary Vasospasm.US cardiology · 2023Review
- Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease: a consensus document from the coronary microvascular dysfunction workstream of the British Heart Foundation/National Institute for Health Research Partnership.Heart (British Cardiac Society) · 2022Review
- Invasive evaluation of coronary microvascular dysfunction.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2022Review
- Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management.Life (Basel, Switzerland) · 2022Review
- Acetylcholine Use in Modern Cardiac Catheterization Laboratories: A Systematic Review.Journal of clinical medicine · 2022Review
- Coronary Endothelium-Dependent Vasomotor Function After Drug-Eluting Stent and Bioresorbable Scaffold Implantation.Journal of the American Heart Association · 2021Article
- Sex Differences in Coronary Function Test Results in Patient With Angina and Nonobstructive Disease.Frontiers in cardiovascular medicine · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundIntracoronary acetylcholine (Ach) provocation testing is the gold standard for assessing coronary endothelial function. However, dosing regimens of Ach are quite varied in the literature, and there are limited data evaluating the optimal dose. We evaluated the dose-response relationship between Ach and minimal lumen diameter (MLD) by sex and studied whether incremental intracoronary Ach doses given during endothelial function testing improve its diagnostic utility.
methodsWe evaluated 65 men and 212 women with angina and no obstructive coronary artery disease who underwent endothelial function testing using the highest tolerable dose of intracoronary Ach, up to 200 μg. Epicardial endothelial dysfunction was defined as a decrease in MLD >20% after intracoronary Ach by quantitative coronary angiography. We used a linear mixed effects model to evaluate the dose-response relationship. Deming regression analysis was done to compare the %MLD constriction after incremental doses of intracoronary Ach.
resultsThe mean age was 53.5 years. Endothelial dysfunction was present in 186 (68.1%). Among men with endothelial dysfunction, there was a significant decrease in MLD/10 µg of Ach at doses above 50 μg and 100 µg, while this decrease in MLD was not observed in women (
conclusionsWomen and men appear to have different responses to Ach during endothelial function testing. In addition to having a greater response to intracoronary Ach at all doses, men also demonstrate an Ach-MLD dose-response relationship with doses up to 200 μg, while women have minimal change in MLD with doses above 50 µg. An incremental dosing regimen during endothelial function testing appears to improve the diagnostic utility of the test and should be adjusted based on the sex of the patient.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.