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June 23, 2012European Journal of Heart FailureOpen Access

Left Ventricular Dysfunction Due to Diffuse Multiple Vessel Coronary Artery Spasm can be Concealed in Dilated Cardiomyopathy

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Key result

In patients with LV dysfunction and positive acetylcholine provocation, calcium channel blockers significantly improved LV ejection fraction from 34% to 54% at 1 year (P<0.01).

Why the study?

Does coronary multispasm contribute to diffuse idiopathic DCM-like LV dysfunction, and do calcium channel blockers improve LV function in these patients?

Population

42 patients with severely depressed left ventricular (LV) function but without significant coronary stenosis

Comparison

Acetylcholine provocation test during coronary… vs Patients with a negative ACh provocation test

Design

Cohort

Follow-up

1 year

Authors

TITakumi InamiVascular / Pulmonary VascularMKMasaharu KataokaVascular / Pulmonary VascularNSNobuhiko ShimuraKyorin University

Discussion

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Implication

May support acetylcholine testing and calcium channel blockers in select LV dysfunction cases; hypothesis-generating for coronary multispasm as a reversible DCM mimic.

Study Design

Type

Observational (n=42)

Structured PICO

Does coronary multispasm contribute to diffuse idiopathic DCM-like LV dysfunction, and do calcium channel blockers improve LV function in these patients?

P
Population
42 patients with severely depressed LV function without significant coronary stenosis, evaluated with an acetylcholine provocation test and followed for 1 year.
E
Exposure
Acetylcholine (ACh) provocation test during coronary angiography, followed by calcium channel blocker therapy for ACh-positive patients
C
Comparator
Patients with a negative ACh provocation test (n=22)
O
Outcome
Change in LV ejection fraction and brain natriuretic peptide (BNP) levels at 1 yearsurrogate

Main Result

Absolute Event Rate: 54% vs 34%

p-value: p=<0.01

Coronary multispasm may mimic idiopathic dilated cardiomyopathy, and identifying these patients via acetylcholine provocation testing allows for effective treatment with calcium channel blockers.

Cite This Study

Inami et al. (2012) conducted an observational in Severely depressed LV function without significant coronary stenosis (n=42). Calcium channel blockers vs. Baseline (pre-treatment) was evaluated on Left ventricular ejection fraction (p=<0.01). In patients with LV dysfunction and positive acetylcholine provocation, calcium channel blockers significantly improved LV ejection fraction from 34% to 54% at 1 year (P<0.01).

synapsesocial.com/papers/6a2415aeabb9266abdadab8bhttps://doi.org/10.1093/eurjhf/hfs103

Topics

Echocardiography
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Is There Evidence Supporting Coronary Revascularization in Patients With Left Ventricular Systolic Dysfunction?2010 · 19 citations
  2. 2Treatment of variant angina with drugs: a survey of 11 cardiology institutes in Japan.1981 · 190 citations
  3. 3Long-term prognosis for patients with variant angina and influential factors.1988 · 468 citations
  4. 4Diffuse and Severe Left Ventricular Dysfunction Induced by Epicardial Coronary Artery Spasm2000 · 23 citations
  5. 5Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm.1986 · 555 citations