Percutaneous coronary intervention completely relieved chest pain in a patient with non-obstructive hypertrophic cardiomyopathy and multivessel coronary artery disease.
Case Report (n=1)
No
Multimodality imaging successfully differentiated epicardial coronary ischemia from intrinsic HCM-related microvascular dysfunction, guiding targeted PCI and symptom resolution in a patient with nHCM and multivessel CAD.
Chest pain in hypertrophic cardiomyopathy (HCM) is commonly attributed to microvascular dysfunction, diastolic dysfunction, or left ventricular outflow tract obstruction, which may obscure concomitant epicardial coronary artery disease (CAD). Identifying the dominant ischemic mechanism is particularly challenging in patients with non-obstructive HCM and multivessel CAD. A 43-year-old man with hypertension, dyslipidemia, and a smoking history presented with progressive chest pain. Transthoracic echocardiography and cardiac magnetic resonance confirmed non-obstructive HCM with asymmetric septal hypertrophy and preserved systolic function. Electrocardiography showed newly developed pathological Q waves in leads III and aVF, and high-sensitivity troponin I was persistently elevated. Contrast-enhanced echocardiography demonstrated hypoperfusion in the posterior, inferior, and inferolateral walls, while cardiac magnetic resonance showed inferior-wall perfusion abnormalities and subendocardial to-near-transmural late gadolinium enhancement, suggesting ischemia beyond intrinsic HCM-related microvascular dysfunction. Coronary angiography revealed multivessel CAD, including diffuse 70%–90% stenosis with focal dissection in the proximal-to-mid right coronary artery (RCA). Based on the concordance among symptoms, electrocardiographic evolution, multimodal imaging, and coronary anatomy, the RCA was identified as the most likely culprit lesion. Percutaneous coronary intervention with drug-eluting stent implantation was successfully performed, resulting in complete relief of chest pain. Postprocedural functional assessment with cardiopulmonary exercise testing and 6-minute walk test revealed no inducible myocardial ischemia or arrhythmias. Follow-up showed no recurrent angina. In patients with HCM who present with chest pain, the key challenge is not only to detect coexisting CAD but also to determine the dominant mechanism underlying the current presentation. Multimodal imaging, together with electrocardiographic changes, biomarkers, and clinical response to treatment, may help identify the clinically relevant culprit lesion and guide individualized management. This study is a case report and does not involve a clinical trial; therefore, trial registration is not applicable.
Wáng et al. (Thu,) conducted a case report in Non-obstructive hypertrophic cardiomyopathy and multivessel coronary artery disease (n=1). Percutaneous coronary intervention with drug-eluting stent was evaluated on Relief of chest pain. Percutaneous coronary intervention completely relieved chest pain in a patient with non-obstructive hypertrophic cardiomyopathy and multivessel coronary artery disease.