Vasospastic heart failure: Multiple spasm may cause transient heart failure?

• Published in: Journal of cardiology 2009-12, Vol.54 (3), p.452-459
• Main Authors: Sueda, Shozo, MD, FJCC, Kohno, Hiroaki, MD, Oshita, Akira, MD, Izoe, Yousuke, MD, Nomoto, Takahiko, MD, Fukuda, Hiroshi, MD
• Format: Article
• Language: English
• Subjects: Acute-Phase Reaction; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - adverse effects; Aged; Asian Continental Ancestry Group; Calcium Channel Blockers - administration & dosage; Calcium Channel Blockers - therapeutic use; Cardiovascular; Coronary artery spasm; Coronary Vasospasm - complications; Coronary Vasospasm - diagnosis; Echocardiography; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Japan; Male; Middle Aged; Pyrimidines; Pyrroles; Risk Factors; Spasm provocation test; Stroke Volume; Ventricular Function, Left
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2009.07.007

Summary Background There have been no reports concerning the correlation between heart failure and coronary artery spasm. Methods and results From January 2000 to December 2007, 201 patients with heart failure were hospitalized at our institution. We could perform coronary arteriography and spasm provocation tests in 37 (22 men, 67 ± 11 years) out of 201 patients with heart failure before discharge. Atrial fibrillation was observed in 13 patients (35%). After controlling heart failure and 24 h cessation of vasoactive drugs, pharmacological spasm provocation tests were performed. Positive spasm was defined as >90%. Coronary spasm was observed in 12 patients (32%) and multiple spasm was recognized in 10 (83%) out of 12 patients. Though ejection fraction on admission was not different between the two groups (42 ± 18% vs. 43 ± 11%, ns), left ventricular end-diastolic and end-systolic dimension after medical therapy over 1 year was significantly smaller in patients with positive spasm than that in patients with negative spasm. There was no difference concerning medications except the administration of nitrate and nicorandil between two groups. Conclusions Coronary artery spasm, especially multiple spasm, may cause transient heart failure in a small part of unknown origin heart failure in Japan.