Author + information
- Received February 16, 1988
- Revision received May 19, 1988
- Accepted June 3, 1988
- Published online November 1, 1988.
- Hiromi Fujii, MD,
- Hirofumi Yasue, MD∗,
- Ken Okumura, MD,
- Koshi Matsuyama, MD,
- Yasuhiro Morikami, MD,
- Hiroo Miyagi, MD and
- Hisao Ogawa, MD
- ↵∗Address for reprints: Hirofumi Yasue, MD, Division of Cardiology, Kumamoto University Medical School, 1-1-1 Honjo, Kumamoto City, Japan 860.
Left ventricular wall motion abnormalities during an attack of coronary spasm induced by hyperventilation were examined with use of two-dimensional echocardiography in 27 patients with variant angina. Transient abnormal wall motion (asynergy) confined to one coronary artery region was found in 18 of the 27 patients and transient abnormal motion extending over more than one coronary artery region in the remaining 9 patients. Spasm of more than one major coronary artery was demonstrated separately by coronary arteriography during an attack induced by injection of acetylcholine or ergonovine in seven of the nine patients who manifested asynergy in more than one coronary artery region. In one patient, spasm was demonstrated in one major coronary artery, and the other coronary arteries were severely stenosed or occluded organically. In the remaining patient, acetylcholine was not injected into both arteries; however, the attack was sometimes associated with ST segment elevation in the anterior leads and at other times in the inferior leads.
Therefore, simultaneous multivessel coronary spasm seems to have occurred in eight of the nine patients who exhibited asynergy in more than one coronary artery region. The 8 patients with simultaneous multivessel coronary spasm had a higher degree and longer duration of ST segment elevation and a higher incidence of arrhythmias during the attack induced by hyperventilation than did the 19 patients with single vessel coronary spasm, and all of them had no significant organic stenosis.
It is concluded that 1) simultaneous multivessel coronary spasm seems to occur in a sizable proportion (30%) of patients with variant angina and can be detected by two-dimensional echocardiography; and 2) an attack of simultaneous multivessel coronary spasm is associated with more severe and more prolonged myocardial ischemia than that of single vessel coronary spasm and it typically occurs in normal or nearly normal coronary arteries.
☆ This work was supported in part by Research Grants for Cardiovascular Diseases from the Ministry of Education (A-60440110) and from the Ministry of Health and Welfare (61C-4), Tokyo, Japan.
- Received February 16, 1988.
- Revision received May 19, 1988.
- Accepted June 3, 1988.