Coronary hemodynamic findings during spontaneous angina in patients with variant angina.

To define more completely regional coronary hemodynamic changes that occur during spontaneous angina pectoris in patients with variant angina, we measured coronary sinus and great cardiac vein blood flow (CSF and GCVF) and aortic and left ventricular pressures before and during spontaneous angina in six patients with variant angina. During spontaneous angina, ECGs in four patients showed evidence for transient anterior regional ischemia (ST-T-wave changes in I, aVL, V,.,) and in two patients showed evidence for transient inferior regional ischemia (ST-T-wave changes in II, III, aVF). During spontaneous angina, CSF decreased in five of six patients (27 ± 10 ml/min,p < 0.05), compared with measurements made during a painfree interval. In all four patients with anterior ischemia, GCVF decreased 34 ± 13 ml/min (p < 0.05). In the two patients with inferior ischemia, GCVF was unchanged, but the difference between CSF and GCVF, an index of inferior regional blood flow, decreased 36 ± 20 ml/min during ischemia. Heart rate was not significantly different during angina, and mean aortic pressure decreased in three patients, increased in two and was unchanged in the other. Left ventricular end-diastolic pressure increased 10 ± 2 mm Hg during spontaneous angina (p < 0.01). These data provide direct evidence that blood flow to the ischemic region during spontaneous angina is decreased in patients with variant angina. These results support the concept that a functionally important decrease in regional myocardial oxygen delivery occurs in certain patients with variant angina coincident with angina and ST-segment and T-wave changes.