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

Takumi Inami, Masaharu Kataoka, Nobuhiko Shimura, Haruhisa Ishiguro, Hideyasu Kohshoh, Hiroki Taguchi, Ryoji Yanagisawa, Yukiko Hara, Toru Satoh, Hideaki Yoshino

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Abstract

Aims Many patients with idiopathic dilated cardiomyopathy (DCM) have been diagnosed on the basis of the exclusion of significant coronary stenosis and the presence of left ventricular (LV) dysfunction. In the present study, we investigated the possibility that coronary multispasm is one of the mechanisms leading to diffuse idiopathic DCM-like LV dysfunction.Methods and resultsForty-two patients with severely depressed LV function but without significant coronary stenosis were enrolled (baseline LV ejection fraction, 33 ±11). An acetylcholine (ACh) provocation test was performed at the time of coronary angiography. In patients with a positive ACh provocation test (n 20), coronary angiography revealed multivessel diffuse coronary spasm with marked electrocardiogram changes. In patients with a negative ACh provocation test (n=22), significant findings compatible with idiopathic DCM were more frequently observed on magnetic resonance imaging (MRI) or in LV biopsies compared with the ACh-positive group (MRI, 73% vs. 12%; and LV biopsy, 71% vs. 0%, respectively; P < 0.01). In the ACh-positive group, LV function significantly improved after the administration of calcium channel blockers (LV ejection fraction, 34 ±12% vs. 54 ±10%; and brain natriuretic peptide, 803 ± 482 pg/mL vs. 69 ± 84 pg/mL, at baseline and 1 year, respectively; P < 0.01).ConclusionsOur results raise the possibility that patients with LV dysfunction due to repeated coronary multispasm are being diagnosed as idiopathic DCM, and that calcium channel blockers may prove to be a promising therapeutic strategy in those patients.

Original languageEnglish
Pages (from-to)1130-1138
Number of pages9
JournalEuropean Journal of Heart Failure
Volume14
Issue number10
DOIs
Publication statusPublished - 2012 Oct 1

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Keywords

  • Acetylcholine provocation
  • Calcium channel blocker
  • Coronary spasm
  • Dilated cardiomyopathy
  • Left ventricular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Inami, T., Kataoka, M., Shimura, N., Ishiguro, H., Kohshoh, H., Taguchi, H., Yanagisawa, R., Hara, Y., Satoh, T., & Yoshino, H. (2012). Left ventricular dysfunction due to diffuse multiple vessel coronary artery spasm can be concealed in dilated cardiomyopathy. European Journal of Heart Failure, 14(10), 1130-1138. https://doi.org/10.1093/eurjhf/hfs103