Improved myocardial perfusion preceding clinical response on bosentan treatment for coronary vasospasm.
Many patients suffer from persistent angina due to coronary vasospasm despite optimal medical treatment. We treated a 46-year-old patient with severe and treatment-resistant coronary vasospasm with the endothelin-receptor antagonist bosentan. Using oxygen-15-labelled water in conjunction with oxygen 15-labelled carbon monoxide positron emission tomography (PET), we measured an impaired coronary flow reserve (CFR) in 6 out of 13 segments directly before the start of bosentan therapy. A repeated PET measurement after 16 weeks of bosentan revealed a completely normalized CFR in this patient. Furthermore, the patient reported less frequent and less severe chest pain. Our data suggest a potential role of endothelin-receptor antagonists for patients with severe coronary vasospasms.
Vermeltfoort
Ilse A C
IA
Department of Nuclear Medicine & PET Research, VU University Medical Centre, Amsterdam, The Netherlands. i.vermeltfoort@vumc.nl
Raijmakers
Pieter G H M
PG
Kamphuisen
Pieter W
PW
D000788:Angina Pectoris, Variant / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001783:Blood Flow Velocity; D000077300:Bosentan; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D049268:Positron-Emission Tomography; D013449:Sulfonamides / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D013449:Sulfonamides; D000077300:Bosentan