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European Heart Journal Advance Access published online on August 21, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp325
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Abnormal coronary reserve and left ventricular wall motion during cold pressor test in patients with previous left ventricular ballooning syndrome

Giuseppe Barletta1,*, Stefano Del Pace2, Maria Boddi2, Riccarda Del Bene1, Claudia Salvadori2, Benedetta Bellandi2, Mirella Coppo2, Elisa Saletti1 and Gian Franco Gensini2

1 Non Invasive Cardiology, Department of Heart and Vessels, AOU Careggi, Florence 50134, Italy
2 Clinical Cardiology 1, Department of Heart and Vessels, AOU Careggi, Florence 50134, Italy

Received 14 October 2008; revised 26 April 2009; accepted 13 July 2009 * Corresponding author. Tel: +39 55 410895, Fax: +39 55 7947578, Email: barlettagius{at}tiscali.it

Aims: To investigate whether and how cold pressor test (CPT) could affect myocardial perfusion and left ventricular (LV) function in patients with previous LV ballooning syndrome (LVBS).

Methods and results: Cold pressor test (3 min hand immersion in ice-water) was performed in 17 women with previous LVBS and in 7 age- and risk factor-matched women with chest pain and normal coronary arteries. At baseline and peak CPT, global and regional LV function, and myocardial perfusion were quantitatively assessed by real-time three-dimensional echocardiography (RT3DE) and myocardial contrast (SonoVue, Bracco) 2D echocardiography (MCE), respectively (Philips iE33 machine, X3-1 and S5-1 probes). Data were analysed off-line (QLab 6.0 software). Peripheral venous catecholamines were assayed by high performance liquid chromatography with electrochemical detection. Cold pressor test induced similar haemodynamic changes and catecholamine increase in controls and LVBS patients. Left ventricular ejection fraction decreased and transient new mid-ventricular and apical motion abnormalities developed in LVBS patients only (quantitative RT3D analysis), without corresponding perfusion defects (MCE). At peak CPT, coronary blood flow and velocity increased (quantitative MCE analysis) in control subjects only.

Conclusion: Cold pressor test induced LV wall motion abnormalities unmatched to regional coronary flow reduction in LVBS patients only. The reduced coronary reserve in response to CPT suggests microvascular dysfunction in LVBS patients.

Key Words: Cold pressor test • Coronary flow • Echocardiography • Tako-Tsubo


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