How to Treat Heart Failure with Reduced Ejection Fraction Complicated with Coronary Artery Spasm? Is Beta-blocker Harmful??

In recent years, some studies have reported coronary artery spasm may result in a small percentage of patients with chronic heart failure. Between April 2014 and March 2017, 33 patients with chronic heart failure but without any coronary stenosis or any valvular diseases were enrolled. An acetylcoline provocation test was performed. Coronary artery spasm was recognized in 24 patients (72.4%) out of 33 patients. The patients who had both LV dysfunction and coronary artery spasm were administered appropriate doses of beta-blockers based on previous studies of the treatment of heart failure in addition to optimized medical therapy for inhibition of coronary artery spasm. All cause death and readmission for heart failure were analyzed. The mean follow up period was 315 ± 128days. The ratio of readmission for heart failure was 4.1% in spasm positive group and 11.1% in spasm negative group. All cause death were 0% in both groups. In 4 patients of spasm positive group, we investigated the course of exercise capacity by cardiopulmonary exercise test for 3 months after discharge. The result of peak VO2 and VE/VCO2 were improved in all patients (peak VO2:22.2 ± 7.26 to 23.8 ± 5.15 ml/min/kg, VE/VCO2:26.1 ± 3.50 to 25.8 ± 3.84). Our result suggested that beta-blockers did not have a harmful effect on chronic heart failure complicated with coronary artery spasm.