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Vasospastic angina and overlapping cardiac disorders in patients resuscitated from cardiac arrest

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Abstract

Background

Vasospastic angina (VSA) reportedly accounts for one form of sudden cardiac arrest (SCA). Intracoronary acetylcholine (ACh) testing is useful for diagnosing VSA although invasive provocation testing after SCA is a clinical challenge. In addition, even if the ACh test is positive, any causal relationship between VSA and SCA is often unclear because patients with VSA may have other underlying cardiac disorders.

Methods

A total of 20 patients without overt structural heart disease who had been fully resuscitated from SCA were included. All patients underwent the ACh provocation test and scrutiny such as cardiac computed tomography or magnetic resonance imaging. Patients were followed up for all-cause death or recurrent SCA including appropriate implantable cardioverter defibrillator therapy.

Results

An ACh provocation test was performed 20 ± 17 days after cardiac arrest. Fifteen out of 20 (75.0%) patients had a positive ACh test and 2 (10.0%) had adverse events such as ventricular tachycardia and transient cardiogenic shock during the test. In patients with a positive ACh test, 6 of 15 (40.0%) patients had other overlapping cardiac disorders such as long QT syndrome, Brugada syndrome, cardiac sarcoidosis, myocarditis, or cardiomyopathy. Long-term prognosis was not different regardless of a positive ACh test or the presence of other cardiac disorders overlapping with VSA.

Conclusions

Three-quarters of the patients who had been resuscitated from SCA had a positive ACh test. Further examinations revealed other overlapping cardiac disorders in addition to VSA in 40% of patients with a positive ACh test.

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References

  1. Ong P, Aziz A, Hansen HS, Prescott E, Athanasiadis A, Sechtem U (2015) Structural and functional coronary artery abnormalities in patients with vasospastic angina pectoris. Circ J 79:1431–1438

    Article  Google Scholar 

  2. Yasue H, Takizawa A, Nagao M, Nishida S, Horie M, Kubota J, Omote S, Takaoka K, Okumura K (1988) Long-term prognosis for patients with variant angina and influential factors. Circulation 78:1–9

    Article  CAS  Google Scholar 

  3. Myerburg RJ, Kessler KM, Mallon SM, Cox MM, deMarchena E, Interian A Jr, Castellanoset A (1992) Life-threatening ventricular arrhythmias in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med 326:1451–1455

    Article  CAS  Google Scholar 

  4. Chevalier P, Dacosta A, Defaye P, Chalvidan T, Bonnefoy E, Kirkorian G, Isaaz K, Denis B, Touboulet P (1998) Arrhythmic cardiac arrest due to isolated coronary artery spasm: long-term outcome of seven resuscitated patients. J Am Coll Cardiol 31:57–61

    Article  CAS  Google Scholar 

  5. Meune C, Joly LM, Chiche JD, Charpentier J, Leenhardt A, Rozenberg A, Carli P, Sauval P, Weber S, Cracan A, Spauldinget C (2003) Diagnosis and management of out-of-hospital cardiac arrest secondary to coronary artery spasm. Resuscitation 58:145–152

    Article  Google Scholar 

  6. Kobayashi N, Hata N, Shimura T, Yokoyama S, Shirakabe A, Shinada T, Tomita K, Murakami D, Takano M, Seino Y, Matsumoto H, Mashiko K, Mizuno K (2013) Characteristics of patients with cardiac arrest caused by coronary vasospasm. Circ J 77:673–678

    Article  Google Scholar 

  7. Tateishi K, Abe D, Iwama T, Hamabe Y, Aonuma K, Sato A (2018) Clinical value of ST-segment change after return of spontaneous cardiac arrest and emergent coronary angiography in patients with out-of-hospital cardiac arrest: diagnostic and therapeutic importance of vasospastic angina. Eur Heart J Acute Cardiovasc Care 7:405–413

    Article  Google Scholar 

  8. Komatsu M, Takahashi J, Fukuda K, Takagi Y, Shiroto T, Nakano M, Kondo M, Tsuburaya R, Hao K, Nishimiya K, Nihei T, Matsumoto Y, Ito K, Sakata Y, Miyata S, Shimokawa H (2016) Usefulness of testing for coronary artery spasm and programmed ventricular stimulation in survivors of out-of-hospital cardiac arrest. Circ Arrhythm Electrophysiol 9:e003798

    Article  Google Scholar 

  9. Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, Shimokawa H, Bairey Merz CN, Coronary Vasomotion Disorders International Study Group (COVADIS) (2017) International standardization of diagnostic criteria for vasospastic angina. Eur Heart J 38:2565–2568

    PubMed  Google Scholar 

  10. Waldmann V, Bougouin W, Karam N, Dumas F, Sharifzadehgan A, Gandjbakhch E, Algalarrondo V, Narayanan K, Zhao A, Amet D, Jost D, Geri G, Lamhaut L, Beganton F, Ludes B, Bruneval P, Plu I, Hidden-Lucet F, Albuisson J, Lavergne T, Piot O, Alonso C, Leenhardt A, Lellouche N, Extramiana F, Cariou A, Jouven X, Marijon E, Paris-SDEC investigators (2018) Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation. Eur Heart J 39:1981–1987

    Article  Google Scholar 

  11. Kitamura T, Fukamizu S, Hojo R, Aoyama Y, Komiyama K, Nishizaki M, Sakurada H, Hiraoka M (2016) Early repolarization pattern and its day-to-day dynamic change as markers for ventricular fibrillation in patients with vasospastic angina. Europace 18:1252–1258

    Article  Google Scholar 

  12. Shimizu W, Noda T, Takaki H, Kurita T, Nagaya N, Satomi K, Suyama K, Aihara N, Kamakura S, Sunagawa K, Echigo S, Nakamura K, Ohe T, Towbin JA, Napolitano C, Priori SG (2003) Epinephrine unmasks latent mutation carriers with LQT1 form of congenital long-QT syndrome. J Am Coll Cardiol 41:633–642

    Article  CAS  Google Scholar 

  13. JCS Joint Working Group (2014) Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2013). Circ J 78:2779–2801

    Article  Google Scholar 

  14. Saito Y, Kitahara H, Shoji T, Tokimasa S, Nakayama T, Sugimoto K, Fujimoto Y, Kobayashi Y (2017) Relation between severity of myocardial bridge and vasospasm. Int J Cardiol 248:34–38

    Article  Google Scholar 

  15. Tateishi K, Saito Y, Kitahara H, Shoji T, Kadohira T, Nakayama T, Fujimoto Y, Kobayashi Y (2018) Safety and usefulness of acetylcholine provocation test in patients with no culprit lesions on emergency coronary angiography. Int J Cardiol 269:27–30

    Article  Google Scholar 

  16. Saito Y, Kitahara H, Shoji T, Tokimasa S, Nakayama T, Sugimoto K, Fujimoto Y, Kobayashi Y (2018) Feasibility and safety of outpatient cardiac catheterization with intracoronary acetylcholine provocation test. Heart Vessels 33:846–852

    Article  Google Scholar 

  17. Sueda S, Kohno H (2019) Transitional changes of acetylcholine spasm provocation test procedures. Cardiovasc Interv Ther. https://doi.org/10.1007/s12928-019-00624-7(Epub ahead of print)

    Article  PubMed  Google Scholar 

  18. Takaoka H, Funabashi N, Ozawa K, Uehara M, Sano K, Komuro I, Kobayashi Y (2018) Improved diagnosis of detection of late enhancement in left ventricular myocardium using 2nd generation 320-Slice CT reconstructed with FIRST in non-ischemic cardiomyopathy. Int Heart J 59:542–549

    Article  Google Scholar 

  19. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C, Document Reviewers, Ackerman M, Belhassen B, Estes NA 3rd, Fatkin D, Kalman J, Kaufman E, Kirchhof P, Schulze-Bahr E, Wolpert C, Vohra J, Refaat M, Etheridge SP, Campbell RM, Martin ET, Quek SC, Heart Rhythm Society; European Heart Rhythm Association, Asia Pacific Heart Rhythm Society (2013) Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 15:1389–1406

    Article  Google Scholar 

  20. Patton KK, Ellinor PT, Ezekowitz M, Kowey P, Lubitz SA, Perez M, Piccini J, Turakhia M, Wang P, Viskin S, American Heart Association Electrocardiography, and Arrhythmias Committee of the Council on Clinical Cardiology, and Council on Functional Genomics, and Translational Biology (2016) Electrocardiographic early repolarization: a scientific statement from the American Heart Association. Circulation 133:1520–1529

    Article  Google Scholar 

  21. Hulten E, Aslam S, Osborne M, Abbasi S, Bittencourt MS, Blankstein R (2016) Cardiac sarcoidosis: state of the art review. Cardiovasc Diagn Ther 6:50–63

    PubMed  PubMed Central  Google Scholar 

  22. JCS 2017 guidelines for diagnosis and management of inherited arrhythmias. https://www.j-circ.or.jp/guideline/pdf/JCS2017_aonuma_h.pdf. Accessed 30 May 2020

  23. JCS 2018 guideline on diagnosis and treatment of cardiomyopathies. https://www.j-circ.or.jp/guideline/pdf/JCS2018_tsutsui_kitaoka.pdf. Accessed 30 May 2020.

  24. Nishi T, Takaoka H, Funabashi N, Nishimura M, Ohara O, Makiyama T, Ueda M, Kajiyama T, Kobayashi Y (2016) Familial lamin A/C mutation cardiomyopathy with arrhythmia substrate detected by cardiac magnetic resonance imaging and electroanatomical mapping. Int J Cardiol 209:248–252

    Article  Google Scholar 

  25. Sueda S, Kohno H, Ochi T, Uraoka T, Tsunemitsu K (2017) Overview of the pharmacological spasm provocation test: comparisons between acetylcholine and ergonovine. J Cardiol 69:57–65

    Article  Google Scholar 

  26. Ong P, Athanasiadis A, Hill S, Vogelsberg H, Voehringer M, Sechtem U (2008) Coronary artery spasm as a frequent cause of acute coronary syndrome: the CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study. J Am Coll Cardiol 52:523–527

    Article  Google Scholar 

  27. Sueda S, Kohno H (2016) Overview of complications during pharmacological spasm provocation tests. J Cardiol 68:1–6

    Article  Google Scholar 

  28. Anzai H, Momiyama Y, Kimura M (1999) Cardiac sarcoidosis complicated by multivessel coronary spasm: a case report. J Cardiol 34:85–91

    CAS  PubMed  Google Scholar 

  29. Matsue Y, Suzuki M, Nishizaki M, Hojo R, Hashimoto Y, Sakurada H (2012) Clinical implications of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmia. J Am Coll Cardiol 60:908–913

    Article  Google Scholar 

  30. Ahn JM, Lee KH, Yoo SY, Cho YR, Suh J, Shin ES, Lee JH, Shin DI, Kim SH, Baek SH, Seung KB, Nam CW, Jin ES, Lee SW, Oh JH, Jang JH, Park HW, Yoon NS, Cho JG, Lee CH, Park DW, Kang SJ, Lee SW, Kim J, Kim YH, Nam KB, Lee CW, Choi KJ, Song JK, Kim YH, Park SW, Park SJ (2016) Prognosis of variant angina manifesting as aborted sudden cardiac death. J Am Coll Cardiol 68:137–145

    Article  Google Scholar 

  31. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL (2018) 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. Heart Rhythm 15:e190–e252

    Article  Google Scholar 

  32. 2018 JCS/JHRS guideline on non-pharmacotherapy of cardiac arrhythmias. https://www.j-circ.or.jp/guideline/pdf/JCS2018_kurita_nogami.pdf. Accessed 30 May 2020.

  33. Fink K, Schwarz M, Feldbrügge L, Sunkomat JN, Schwab T, Bourgeois N, Olschewski M, von Zur MC, Bode C, Busch HJ (2010) Severe endothelial injury and subsequent repair in patients after successful cardiopulmonary resuscitation. Crit Care 14:R104

    Article  Google Scholar 

  34. Sueda S (2020) Pharmacological spasm provocation testing in 2500 patients: provoked spasm incidence, complications and cardiac events. Heart Vessels 35:1368–1377

    Article  Google Scholar 

  35. Sueda S, Fujimoto K, Sasaki Y, Sakaue T, Yoshii T, Habara H, Kohno H (2019) Differential incidence and morphology of provoked spasm between intracoronary acetylcholine and ergonovine testing: recommendation of supplementary use. Heart Vessels 34:745–754

    Article  Google Scholar 

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Acknowledgements

We thank all of the hospital staff who assisted in data collection.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan

    Kazuya Tateishi, Yuichi Saito, Hideki Kitahara, Hiroyuki Takaoka, Takashi Nakayama, Yoshihide Fujimoto & Yoshio Kobayashi

  2. Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan

    Yusuke Kondo

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  1. Kazuya Tateishi
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Correspondence to Kazuya Tateishi.

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Tateishi, K., Saito, Y., Kitahara, H. et al. Vasospastic angina and overlapping cardiac disorders in patients resuscitated from cardiac arrest. Heart Vessels 36, 321–329 (2021). https://doi.org/10.1007/s00380-020-01705-x

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