Noninvasive diagnosis of coronary spasm

: The objective of this work was to compare the sensitivity of non-invasive tests used for the diagnosis of variant angina pectoris (VAP). In a group of 38 patients with VAP the authors compare the sensitivity of the cold test (CT), hyperventilation test (HT), handgrip (HG), bicycle ergometry (BE) and a newly suggested combination of hyperventilation with HG and BE resp. The authors evaluated first the sensitivity of ST elevations which are an entirely specific sign and in particular denivelization of ST (by depression or elevation) which is a less specific sign. The sensitivity of different tests was as follows: CT 5% and 5% resp., HT 18% and 39% resp., HG 13% and 29% resp., BE 26% and 66% resp., HV+HG 37% and 63% resp., HV+BE 50% and 87% resp. Then the authors assessed the sensitivity of repeated examinations HV+HG 47% and evaluation during denivelization of ST 63%, HV+BE 66% and 89% resp. The authors evaluated moreover the sensitivity of ST elevations in patients according to the activity of the disease. Patients with at least five stenocardias per week had a higher sensitivity, as compared with patients with less frequent attacks: HV+HG 42% and 25% resp., HV+BE 60% and 33% resp. The highest sensitivity was found in a combination of HV+BE. Repetition of the test in case of a negative result increased markedly the sensitivity, a higher sensitivity was found also in patients with more frequent stenocardias.