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Left ventricular dysfunction due to diffuse multiple vessel coronary artery spasm can be concealed in dilated cardiomyopathy
Author(s) -
Inami Takumi,
Kataoka Masaharu,
Shimura Nobuhiko,
Ishiguro Haruhisa,
Kohshoh Hideyasu,
Taguchi Hiroki,
Yanagisawa Ryoji,
Hara Yukiko,
Satoh Toru,
Yoshino Hideaki
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs103
Subject(s) - medicine , cardiology , provocation test , ejection fraction , dilated cardiomyopathy , heart failure , cardiomyopathy , magnetic resonance imaging , coronary vasospasm , stenosis , coronary angiography , radiology , myocardial infarction , pathology , alternative medicine
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 results Forty‐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). Conclusions Our 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.