Coronary vasospasm as the underlying cause for chest pain in patients with PVB19-myocarditis

Ali Yilmaz ^1*, Heiko Mahrholdt ¹, Anastasios Athanasiadis ¹, Holger Vogelsberg ¹, Gabriel Meinhardt ¹, Matthias Voehringer ¹, Eva-Maria Kispert ¹, Christina Deluigi ¹, Hannibal Baccouche ¹, Evgeny Spodarev ², Karin Klingel ³, Reinhard Kandolf ³ and Udo Sechtem ¹

¹ Robert-Bosch-Krankenhaus, Germany
² Institute of Stochastics, University of Ulm, Germany
³ Department of Molecular Pathology, University of Tuebingen, Germany

^* To whom correspondence should be addressed. E-mail: ali.yilmaz{at}rbk.de.

Accepted 22 January 2008

Abstract

Objective To evaluate the incidence of coronary vasospasm as a possible pathophysiological mechanism causing chest pain symptoms in patients with clinically suspected myocarditis.

Design and setting Prospective study in a teaching hospital.

Patients 85 patients who presented with atypical chest pain at our hospital and demonstrated clinical signs suggestive of myocarditis.

Main outcome measures Incidence of coronary vasospasm demonstrated by intracoronary acetylcholine(ACh)-testing.

Methods The combined procedure of intracoronary ACh-testing and endomyocardial biopsy (EMB) was performed after ruling out significant coronary artery disease (CAD). EMBs were analysed for myocardial inflammation by immunohistological methods and for virus genome persistence.

Results Pathological biopsy results including myocardial inflammation and/or detection of viral genomes were found in 55 (64.7%) patients while 30 (35.3%) patients revealed neither cardiac inflammation nor viral genomes and were defined as control group. Coronary vasospasm was demonstrated in 39 (70.9%) patients with pathological compared to only 12 (40.0%) with normal biopsy results (p=0.01). Patients with isolated PVB19-infection (n=22) demonstrated a significantly higher incidence of coronary vasospasm compared to both those with isolated HHV6-infection (86.4% vs. 46.7%; p=0.025) and those with normal biopsy results (86.4% vs. 40.0%; p=0.0013). Univariate and multivariate logistic regression analysis revealed that only PVB19-infection was independently correlated with coronary vasospasm (OR=4.9, 95%-CI=1.56–15.28, p=0.006).

Conclusions Coronary vasospasm is one of the main reasons for atypical chest pain in patients with clinical signs of myocarditis and biopsy-proven PVB19-myocarditis in the absence of significant CAD.

Keywords: Biopsy, Coronary vasospasm, Myocarditis, Viruses

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Friedrich, M. G., Sechtem, U., Schulz-Menger, J., Holmvang, G., Alakija, P., Cooper, L. T., White, J. A., Abdel-Aty, H., Gutberlet, M., Prasad, S., Aletras, A., Laissy, J.-P., Paterson, I., Filipchuk, N. G., Kumar, A., Pauschinger, M., Liu, P., for the International Consensus Group on Cardiovas, (2009). Cardiovascular magnetic resonance in myocarditis: A JACC White Paper.. J Am Coll Cardiol 53: 1475-1487 [Abstract] [Full Text]  
• Mahrholdt, H., Sechtem, U. (2009). Noninvasive differentiation between active and healed myocarditis by cardiac magnetic resonance: are we there yet?. J Am Coll Cardiol Img 2: 139-142 [Full Text]