Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease – Myocarditis 2063
Mechanisms of angina in patients with biopsy-proven viral myocarditis: insights from intracoronary acetylcholine testing
A. Seitz1, V. Martinez Pereyra1, A. Hubert1, K. Klingel2, R. Bekeredjian1, U. Sechtem1,P.Ong1 1Robert Bosch Hospital, Stuttgart, Germany; 2University Hospital of Tuebingen, Cardiopathology, Tuebingen, Germany Funding Acknowledgement: Type of funding source: Foundation. Main funding source(s): Robert-Bosch-Stiftung; Berthold-Leibinger-Stiftung
Background: Patients with myocarditis often present with angina pectoris Results: Patients were 49±16 years old, 62% were male and left ventric- Downloaded from https://academic.oup.com/eurheartj/article/41/Supplement_2/ehaa946.2063/6003749 by guest on 29 September 2021 despite unobstructed coronary arteries. The underlying pathophysiological ular ejection fraction was 54±16%. Most frequent viruses were parvovirus mechanism of angina in these patients remains to be elucidated. Coronary B19 (PVB19, 59%) and human herpes virus 6 (HHV6, 26%), 2 patients artery spasm is a well-known cause of angina in patients with unobstructed had combined PVB19/HHV6 infection and 3 patients other herpesviruses coronary arteries. In this study, we sought to assess the frequency of coro- (CMV, EBV, VZV). Epicardial spasm was observed in 10 patients (29%) nary vasomotor disorders in patients with biopsy-proven viral myocarditis. during ACh testing and microvascular spasm was found in 11 patients Methods: In total, 700 consecutive patients who underwent endomyocar- (32%). The rate of coronary spasm (epicardial and microvascular) was dial biopsy for suspected myocarditis between 2008 and 2018 were ret- higher in the PVB19 subgroup compared to HHV6 (80% vs. 33%, p=0.031). rospectively screened. Of these patients, viral myocarditis was confirmed In particular, there was a higher prevalence of microvascular spasm in in 303 patients defined as histological/immunohistological evidence of my- PVB19 compared to HHV6 (45% vs. 0%, p=0.018). ocardial inflammation and presence of viral genome confirmed by PCR. Conclusion: We observed a high prevalence of microvascular and epi- Of these patients, 34 patients had angina despite unobstructed coro- cardial spasm in patients with biopsy-proven viral myocarditis suggesting nary arteries and underwent intracoronary acetylcholine (ACh) provoca- coronary spasm as a potential underlying mechanism for angina in these tion testing in search of coronary spasm. Epicardial spasm was defined patients. Microvascular spasm was most often observed in patients with as acetylcholine-induced reproduction of the patient’s symptoms associ- PVB19-associated myocarditis. ated with ischemic ECG changes and >90% epicardial vasoconstriction. Microvascular spasm was defined as symptom reproduction and ECG changes in the absence of significant epicardial vasoconstriction.
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