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Hyperventilation testing (HVT) is defined as a class IIa recommendation to diagnose VSA by the Japanese Society of Cardiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this systematic review and meta\u2010analysis reported according to the PRISMA statement, we review the mechanisms, methods, modalities and diagnostic accuracy of non\u2010invasive HVT for the diagnostic of VSA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 106 articles published between 1980 and 2022 about VSA and HVT were included in the systematic review, among which 16 were included in the meta\u2010analysis for diagnostic accuracy. Twelve electrocardiogram\u2010HVT studies including 804 patients showed a pooled sensitivity of 54% (95% confidence intervals [CI]; 30%\u201376%) and a pooled specificity of 99% (95% CI; 88%\u2013100%). Four transthoracic echocardiography\u2010HVT studies including 197 patients revealed a pooled sensitivity of 90% (95% CI; 82%\u201394%) and a pooled specificity of 98% (95% CI; 86%\u2013100%). Six myocardial perfusion imaging\u2010HVT studies including 112 patients yielded a pooled sensitivity of 95% (95% CI; 63%\u2013100%) and a pooled specificity of 78% (95% CI; 19%\u201398%). Non\u2010invasive HVT resulted in a low rate of adverse events, ventricular arrhythmias being the most frequently reported, and were resolved with the administration of nitroglycerin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Non\u2010invasive HVT offers a safe alternative with high diagnostic accuracy to diagnose VSA in patients with otherwise undiagnosed causes of chest pain.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.14178","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T09:33:26Z","timestamp":1707816806000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta\u2010analysis"],"prefix":"10.1111","volume":"54","author":[{"given":"Laurie\u2010Anne","family":"Boivin\u2010Proulx","sequence":"first","affiliation":[{"name":"Ottawa Heart Institute, University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Marquis\u2010Gravel","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, University of Montreal  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Rousseau\u2010Saine","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, University of Montreal  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Harel","sequence":"additional","affiliation":[{"name":"Montreal Heart Institute, University of Montreal  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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