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BMIPP Imaging in Out-of-Hospital Cardiac Arrest: Exercise-Induced Vasospastic Angina With Ventricular Fibrillation
Hirohiko Aikawa1, Kota Murai2, Shimpei Seiki3
1Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Osaka, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Background:
Vasospastic angina (VSA) is a potential cause of out-of-hospital cardiac arrest (OHCA); however, diagnosis can be challenging when clinical evidence of ischemia is limited, making the indication for invasive spasm provocation testing uncertain. Iodine-123 β-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) reflects postischemic "ischemic memory" and can noninvasively suggest myocardial ischemia.
Case Summary:
We report a 51-year-old man with exercise-related chest pain followed by ventricular fibrillation and OHCA. Emergency coronary angiography after return of spontaneous circulation showed no significant stenosis, whereas BMIPP SPECT imaging demonstrated reduced uptake in the inferior, posterolateral, apical, and septal regions. Subsequent ergometrine provocation testing provoked subocclusion of the left anterior descending artery. Cardiac magnetic resonance revealed no findings of cardiomyopathy or left ventricular thrombus. Based on the exertional symptom pattern, the case was diagnosed as exercise-induced VSA.
Discussion:
BMIPP SPECT imaging may guide decision-making on invasive spasm provocation testing in OHCA survivors with limited ischemic evidence.
Take-Home Messages:
Exercise-induced VSA should be recognized as a potential cause of ventricular fibrillation and OHCA. BMIPP SPECT imaging can guide decisions regarding the indication for invasive coronary spasm provocation testing in OHCA survivors with limited evidence of ischemia.
