Clinical application of multi-detector computed tomography coronary angiography and global longitudinal strain for diagnosis of multi-vessel coronary artery spasm: Case reports

Background Diagnosis of epicardial coronary artery spasm, which is considered the cause of vasospastic angina, can be achieved through the coronary angiography (CAG) with a pharmacologic provocation test. However, this procedure is thought to have a potential risk of complications. Although multi-detector computed tomography coronary angiography (MDCTA) is proposed as the alternative test for diagnosis of spastic coronary artery, myocardial ischemia does not always coincide with coronary artery stenosis. MDCTA combined with echocardiographic left ventricular global longitudinal strain (LV GLS) is an innovative noninvasive diagnostic method expected to detect multivessel coronary artery spasm in patients with vasospastic angina. Case summary We report two cases of vasospastic angina caused by multivessel coronary artery spasm, which were confirmed using MDCTA and echocardiographic LV GLS. Discussion In patients with suspected vasospastic angina, MDCTA and echocardiographic LV GLS during spontaneous attacks could be used to document the coronary artery vasospasm and associated myocardial ischemia. These noninvasive diagnostic techniques could be considered a new alternative for patients with suspected vasospastic angina who exhibit certain characteristics, such as nitrate-responsive and resting chest pain and no history of significant coronary atherosclerosis. This approach may be particularly useful when these patients present to the emergency department during a spontaneous vasospasm.