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Left ventricular dysfunction due to diffuse multiple vessel coronary artery spasm can be concealed in dilated

Takumi Inami1, Masaharu Kataoka, Nobuhiko Shimura

  • 1Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.

European Journal of Heart Failure
|June 21, 2012
PubMed

Insights

Coronary multispasm may be misdiagnosed as idiopathic dilated cardiomyopathy (DCM). Acetylcholine provocation tests identified spasm, and calcium channel blockers improved left ventricular (LV) function in affected patients.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Medical Diagnostics

Background:

  • Idiopathic dilated cardiomyopathy (DCM) is often diagnosed by excluding coronary artery disease and identifying left ventricular (LV) dysfunction.
  • Coronary artery multispasm is investigated as a potential cause of DCM-like LV dysfunction.

Purpose of the Study:

  • To investigate coronary multispasm as a cause of idiopathic DCM.
  • To assess the efficacy of calcium channel blockers in patients with LV dysfunction due to coronary multispasm.

Main Methods:

  • Forty-two patients with LV dysfunction and no significant coronary stenosis underwent acetylcholine (ACh) provocation testing during coronary angiography.
  • Patients were categorized based on ACh test results (positive or negative).
  • Left ventricular function, MRI, and LV biopsies were assessed. Treatment response to calcium channel blockers was evaluated in the positive group.

Main Results:

  • Twenty patients (48%) had a positive ACh test, showing multivessel coronary spasm and ECG changes.
  • Patients with a negative ACh test more frequently showed idiopathic DCM findings on MRI (73%) and LV biopsy (71%).
  • In the ACh-positive group, LV ejection fraction improved significantly (34% to 54%) after calcium channel blocker treatment, with reduced brain natriuretic peptide levels.

Conclusions:

  • Coronary multispasm may be misdiagnosed as idiopathic DCM.
  • Acetylcholine provocation testing can identify patients with coronary multispasm.
  • Calcium channel blockers represent a potential therapeutic strategy for these patients.
Abstract

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