Objectives This study sought to determine whether a newly-combined test, ac
celerated exercise following mild hyperventilation (HV) is more beneficial
to detect ischaemic evidence in patients with pharmacology-induced coronary
artery spasm (CAS) and luminal narrowing of > 75% than classic methods.
Methods and Results Forty consecutive patients who all had luminal narrowin
g of > 75% but < 90% and pharmacology-induced coronary vasospasms of fixed
lesions were involved in this study. In these patients, initial HV test, fo
llowed by treadmill (TM) exercise test and lastly the newly combined test w
ere performed on three consecutive days. Of the 40 patients, firstly six, s
econdarily 16 and lastly 32 had positive responses to the HV test, TM exerc
ise test, and newly combined test, respectively. The remaining six patients
(15%) had negative results, although the triple sequential tests were perf
ormed. Thus, sensitivity of the HV test, the TM exercise test, and the newl
y combined test was 15% (6/40), 40% (16/40), and 84% (32/38), respectively.
Specificity of the three tests were all 100% (46/46). Non-sustained ventri
cular tachycardia and hypotension were observed in two (5%) patients. Howev
er, no serious or irreversible complications were encountered in this study
Conclusions We recommend the newly combined protocol rather than the classi
c tests for the detection of ischaemic evidence in patients with coronary s
pastic angina and fixed stenosis. Coron Artery Dis 12:295-303 (C) 2001 Lipp
incott Williams & Wilkins.