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Coronary vasospasm as the underlying cause for chest pain in patients with PVB19-myocarditis
  1. Ali Yilmaz (ali.yilmaz{at}rbk.de)
  1. Robert-Bosch-Krankenhaus, Germany
    1. Heiko Mahrholdt
    1. Robert-Bosch-Krankenhaus, Germany
      1. Anastasios Athanasiadis
      1. Robert-Bosch-Krankenhaus, Germany
        1. Holger Vogelsberg
        1. Robert-Bosch-Krankenhaus, Germany
          1. Gabriel Meinhardt
          1. Robert-Bosch-Krankenhaus, Germany
            1. Matthias Voehringer
            1. Robert-Bosch-Krankenhaus, Germany
              1. Eva-Maria Kispert
              1. Robert-Bosch-Krankenhaus, Germany
                1. Christina Deluigi
                1. Robert-Bosch-Krankenhaus, Germany
                  1. Hannibal Baccouche
                  1. Robert-Bosch-Krankenhaus, Germany
                    1. Evgeny Spodarev
                    1. Institute of Stochastics, University of Ulm, Germany
                      1. Karin Klingel
                      1. Department of Molecular Pathology, University of Tuebingen, Germany
                        1. Reinhard Kandolf
                        1. Department of Molecular Pathology, University of Tuebingen, Germany
                          1. Udo Sechtem
                          1. Robert-Bosch-Krankenhaus, Germany

                            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.

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