Effects of Anti-vasospastic Agents in Japanese Patients with Dilated Cardiomyopathy and Coronary Vasospasm.

Abstract

SUMMARYThe pathogenesis of dilated cardiomyopathy (DCM) is unknown, but clinical evidence suggests that coronary vasospasm is associated with the development of DCM in some cases. In the present study, we aimed to clarify the prevalence of coronary vasospasm in patients with DCM, the characteristics of patients with DCM and coronary vasospasm, and the effects of anti-vasospastic agents on patients with DCM and coronary vasospasm. This study included 18 consecutive patients with DCM who underwent cardiac catheterization with ergonovine provocation testing. The patient was diagnosed as having coronary vasospasm if ergonovine induced coronary vasoconstriction ≥75% diameter narrowing was observed compared to the diameter after nitroglycerin administration. Six (33%) patients were found to have coronary vasospasm and anti-vasospastic agents were added after the cardiac catheterization. The prevalence of atrial fibrillation in the patients with DCM and coronary vasospasm was greater than that in DCM without coronary vasospasm [67% vs 8% (P<0.05)]. The left ventricular end-diastolic dimension decreased from 61 mm (56/64) to 55 mm (53/56) (median, 25th/75th percentile, P<0.05) and the left ventricular ejection fraction increased from 36% (32/40) to 47% (46/48) (median, 25th/ 75th percentile, P<0.05) after the administration of anti-vasospastic agents and 4 of the 6 patients improved symptomatically. Therefore, ergonovine provocation testing is useful in identifying patients with DCM and coronary vasospasm, in whom cardiac performance is expected to be improved with anti-vasospastic agent therapy. DCM patients with atrial fibrillation may be a clue for identifying patients with coronary vasospasm. (Jpn Heart J 2002; 43: 333-342)

Impact of Delta-Sarcoglycan Gene Polymorphism on the Occurrence of Coronary Spastic Angina in Japanese Patients With Hypertrophic Cardiomyopathy

“…25 It has been reported that CSA might cause heart failure similar to dilated cardiomyopathy. [26][27][28][29] These reports suggested that myocardial ischemia because of coronary spasm in HCM might play a potential role for the conversion of HCM to dilated cardiomyopathy. The transition from HCM to the dilated state is a critical prognostic factor in patients with HCM.…”

“…30 Previously, several reports have shown that vasodilating agents, including calcium-channel blockers and nitrates, could improve cardiac dysfunction as a result of CSA. [26][27][28][29] Because calcium-channel blockers improved vascular dysfunction and prevented progression of cardiomyopathy in sarcoglycan-deficient animals, 31,32 calcium-channel blockers could be clinically effective medications for Japanese HCM patients. Coronary spasm might be a crucial event leading to myocardial ischemia, heart failure and cardiac sudden death in patients with HCM.…”

Heart Failure in Which Coronary Spasms Played an Important Role

“…It is well known that coronary spasms cause not only anginal attacks, but also fatal arrhythmia and sudden death (4). Contrary reports have also stated that coronary spasms may play a role in the development of heart failure (5)(6)(7)(8). In this study, we report the case of a patient with heart failure due to coronary spasms, as suggested by the clinical and pathological findings.…”

“…There have been several reports investigating the relationship between heart failure and coronary spasms (5)(6)(7)(8)(9)(10)(11)(12). The frequency of the provocation of coronary spasms in patients with LV dysfunction ranges from 2.4% to 47.6% (5-9, 12).…”

Overview of the Acetylcholine Spasm Provocation Test

“…Coronary artery spasm may be involved in the genesis of various cardiac disorders, such as acute coronary syndrome, unstable angina, serious fatal arrhythmia, sudden cardiac death, syncope, transient heart failure, and atypical chest pain . As clinical noninvasive methods, we employ 24‐hour Holter recording, exercise testing, the hyperventilation test, cold stress test, and cardiac scintigraphy .…”