Ultrasound shear wave elastography imaging of common carotid arteries in patients with Spontaneous Coronary Artery Dissection (SCAD)

Abstract Background Shear wave elastography (SWE) is emerging as a valuable clinical tool for a variety of conditions. The aim of this pilot study was to assess the potential of SWE imaging of the common carotid arteries (CCA) in patients with spontaneous coronary artery dissection (SCAD), a rare but potentially life-threatening condition, hypothesized to be linked to changes in vessel wall elasticity. Methods Ultrasound shear wave elastography (SWE) estimates of artery wall elasticity were obtained from the left and right CCAs of 89 confirmed SCAD patients and 38 non-dissection controls. SWE images obtained over multiple cardiac cycles were analysed by a blinded observer to estimate elasticity in the form of a Young’s Modulus (YM) value, across regions of interest (ROI) located within the anterior and posterior CCA walls. Results YM estimates ranged from 17 to 133 kPa in SCAD patients compared to 34 to 87 kPa in non-dissection controls. The mean YM of 55 [standard deviation (SD): 21] kPa in SCAD patients was not significantly different to the mean of 57 [SD: 12] kPa in controls, p = 0.32. The difference between groups was 2 kPa [95% Confidence Interval − 11, 4]. Conclusions SWE imaging of CCAs in SCAD patients is feasible although the clinical benefit is limited by relatively high variability of YM values which may have contributed to our finding of no significant difference between SCAD patients and non-dissection controls.

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Common carotid artery stiffness in patients with Spontaneous Coronary Artery Dissection (SCAD) is comparable to non-dissection controls

10.21203/rs.3.rs-30725/v1 ◽

2020 ◽

Author(s):

*Fahad F Almutairi ◽

*Abtehal Al-hussaini ◽

Anne-Marie Marsh ◽

Nilesh J Samani ◽

Gerry P McCann ◽

...

Keyword(s):

Coronary Artery ◽

Carotid Artery ◽

Common Carotid Artery ◽

Arterial Dissection ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Significant Difference ◽

The Mean ◽

The Difference

Abstract Background: Arterial dissection is a rare but potentially life-threatening condition, hypothesized to be linked to changes in vessel wall elasticity. This study aimed to provide an insight into the pathophysiology of arterial dissection by assessing whether elasticity of the common carotid artery (CCA) differs between patients with confirmed spontaneous coronary artery dissection (SCAD) and non-dissection controls. Methods: Ultrasound shear wave elastography (SWE) estimates of artery wall elasticity were obtained from the left and right CCAs of 89 confirmed SCAD patients and 38 non-dissection controls. SWE images obtained over multiple cardiac cycles were analysed by a blinded observer to estimate elasticity in the form of a Young’s Modulus (YM) value, across regions of interest (ROI) located within the anterior and posterior CCA walls. A confidence limit on the difference in mean YM between SCAD patients and non-dissection controls was estimated. Results: YM estimates ranged from 17 to 133 kPa in SCAD patients compared to 34 to 87 kPa in non-dissection controls. The mean YM of 55 [SD: 21] kPa in SCAD patients was not significantly different to the mean of 57 [SD: 12] kPa in controls, p= 0.32. The difference between groups was 2 kPa [95%CI: -11, 4]. Conclusions: We found no evidence of a significant difference in elasticity of the CCA between SCAD patients and non-dissection controls. This suggests that widespread changes in arterial compliance are not a major factor in the pathogenesis of arterial dissection.

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AB0498 CHARACTERISTICS AND OUTCOME OF CORONARY ARTERY LESIONS DUE TO POLYARTERITIS NODOSA: ANALYSIS OF A SINGLE CENTER COHORT IN CHINA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4343 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1547.2-1547

Author(s):

C. Lai ◽

L. Zhao ◽

J. Zhou ◽

D. Xu ◽

X. Tian ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Artery ◽

Polyarteritis Nodosa ◽

Artery Dissection ◽

Renal Infarction ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Lesions ◽

Coronary Artery Dissection ◽

Significant Difference

Background:Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that mainly affects medium-sized muscular arteries. The coronary artery could be affected. Some severe cases can lead to spontaneous coronary artery dissection (SCAD) and about 0.02% will die abruptly. Early diagnosis will improve prognosis, but relative studies are all case reports so far.Objectives:To investigate the clinical characteristics, risk factors and outcome of patients with polyarteritis nodosa (PAN) complicated with coronary artery lesions in China.Methods:Data of 158 patients with PAN who were admitted to Peking Union Medical College Hospital from September 1986 to September 2019 were retrospective collected. Data were analyzed and compared according to with and without coronary artery lesions due to PAN.Results:17 (10.8%) patients with PAN had the coronary artery lesions due to PAN. The age at coronary artery lesion was 36.9±10.3 years. 12 (70.6%) patients were male. There are not statistical differences between two groups in common risk factors of coronary arterial atherosclerosis including smoking, hypertension, diabetes mellitus and hyperlipidemia. Most of them are multi-vessel lesions (8 cases are triple-vessel lesions and 3 cases are bi-vessel lesions). Type of coronary artery affected is shown mainly in stenosis (13 cases). Myocardial infarction are shown in 8 cases (47.1%). Compared to patients without coronary artery lesions, patients with coronary artery lesions had less nervous system involvement (17.6% vs.46.8%) and elevated number of leukocyte (17.6% vs.56%). Besides, patients with coronary artery affected exhibit more cranial and carotid artery involvement(29.4% vs. 5.0%), renal artery involvement (41.2% vs.17.0%), coeliac artery involvement (58.8% vs.27.0%), new onset hypertension (47.1% vs.14.5%), renal infarction (27.3% vs.5.4%, ) and higher proportion of 2009 Five-factor score (FFS)≥2 (62.5% vs.15.6%). All patients with coronary artery lesions received at least moderate dose of prednisone and CTX except one refused medication. 3 cases underwent interventional therapy. Stent placement was performed on 2 of them, and in-stent restenosis was appeared in a patient one year later. 2 cases died,one for vascular rupture after coronary aneurysmsutrue plus coronary artery bypass grafting, another for myocardial infarction after stopping immunosuppressant therapy himself.Survival analysis showed patients with digital g angrene had poor prognosis though no significant difference(p=0.055).Conclusion:PAN with coronary artery lessions are not uncommon. These patients exhibit young age, more proportion of multi-vessel of coronary artery involvement, more combined involvments of other organ arteries and more severe disease.References:[1]Munguti CM, Ndunda PM, Muutu TM. Sudden Death From Spontaneous Coronary Artery Dissection Due to Polyarteritis Nodosa. Cureus, 2017;9 (10), e1737[2]Kritta nawong C, Kumar A, Johnson KW, et al.Conditions and Factors Associated With Spontaneous Coronary Artery Dissection (From a National Population-Based Cohort Study).Am J Cardiol, 2019; 123 (2): 249-253[3]Hwang J, Yang JH, Kim DK, Cha HS.Polyarteritis Nodosa Involving Renal and Coronary Arteries. J Am Coll Cardiol. 2012;59(7):e13Disclosure of Interests: :Chinchih Lai: None declared, Lin Zhao: None declared, Jiaxin Zhou: None declared, Dong Xu: None declared, Xinping Tian: None declared, Xiaofeng Zeng Consultant of: MSD Pharmaceuticals, Fengchun Zhang: None declared

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Spontaneous coronary artery dissection – contemporary management and outcome of a national cohort

European Heart Journal ◽

10.1093/ehjci/ehaa946.1658 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Wilander ◽

E Swahn ◽

N Johnston ◽

L Jonasson ◽

C Pagonis ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery ◽

Coronary Intervention ◽

Statin Treatment ◽

Artery Dissection ◽

Funding Source ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Significant Difference ◽

National Cohort

Abstract Background Spontaneous coronary artery dissection (SCAD) is proposed to cause 1–4% of all acute myocardial infarctions (AMI). The aim of this study was to conduct a first description of Swedish SCAD patients regarding the prevalence of risk factors, treatment and prognosis. Method All patients with AMI registered in the Swedish Coronary Angiography and Angioplasty Register (SCAAR) December 2015 until December 2017 were included. The index angiographies of the SCAD patients were reevaluated by an independent angiographer at each center. Patients with non-SCAD AMI (n=31670) were used for comparison. Results SCAD was identified in 137 patients with AMI (100 women, 37 men). The SCAD population was younger than the non-SCAD population 53.9 (51.7–56.1) vs 68.5 (68.3–68.6) years, more often women (73.0 vs 30.7%) and presented with less risk factors: diabetes 2.9 vs 20.8%; hypertension 27.0 vs 57.6%; smoking 41.2 vs 58.1%; statin therapy 12.4 vs 36.9% and previous AMI 7.3 vs 19.6% (p<0.001 for all comparisons). SCAD patients less frequently underwent percutaneous coronary intervention (PCI) 43.1 vs 70.8% (p<0.001) and received less statin treatment, 78.9 vs 91.5% (p<0.001). There was no significant difference regarding treatment with aspirin or double antiplatelet therapy at discharge: 93 vs 89.7% (p=0.45) and 86.7 vs 84.2%, respectively (p=0,43). There was no significant difference in one-year mortality 6.6 vs 8.2% (p=0.57). Conclusions With a current prevalence of 0.43% of all Swedish AMIs, data supports SCAD being an underdiagnosed condition with a prognosis resembling that of non-SCAD AMI. Furthermore, SCAD patients are younger and harbor less cardiovascular risk factors. While significant differences in management are present, current therapeutic strategies of the two groups are similar, indicating overtreatment of SCAD. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swedish Heart-Lung foundation, ALF funding

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Abstract 15755: Differences in Patient Characteristics of Peripartum Spontaneous Coronary Artery Dissection

Circulation ◽

10.1161/circ.142.suppl_3.15755 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nowrin Haque ◽

Esther S Kim

Keyword(s):

Coronary Artery ◽

Patient Characteristics ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Cross Sectional ◽

Vascular Abnormalities ◽

Imaging Results ◽

Significant Difference ◽

Cross Sectional Imaging

Background: Spontaneous coronary artery dissection (SCAD) is an important cause of acute myocardial infarction in women. The peripartum period, defined as the last month of pregnancy to three months post-delivery, is known to be associated with SCAD. However, differences in patient characteristics between those with non-peripartum SCAD (npSCAD) and peripartum SCAD (pSCAD) are ill-defined. It is also unknown if the prevalence of extracoronary vascular abnormalities (EVAs) or SCAD recurrence differ between patients with npSCAD and pSCAD. Methods: Patients presenting to a dedicated SCAD clinic were enrolled in a single-center registry. Baseline characteristics, SCAD presentation, lab and imaging results, and recurrent SCAD events were assessed. All patients were screened for EVAs, defined as fibromuscular dysplasia (FMD), aneurysm, pseudoaneurysm, and dissection with cross-sectional imaging. Patient characteristics, clinical presentation, presence of EVAs, and recurrent SCAD events were stratified by peripartum status. Results: 125 SCAD patients were identified from June 2016 to March 2020. Mean age (SD) at 1st SCAD event was 45.8 (10.1) years, 94.4% were female, and 15.2% (19/125) of patients were peripartum. Differences in patient characteristics between npSCAD and pSCAD are outlined in the table. npSCAD patients were older (47.5 (9.76) vs 35.6 (0.93), p= 0.0001) at the time of their 1st SCAD event and had increased rates of hypertension (35.6% (37/105) vs 11.1% (2/18), p=0.04). Those with pSCAD had higher rates of SCAD in the left anterior descending artery (LAD) (64.8% (64/125) vs 89.5% (17/19), p=0.03). There was no significant difference in the prevalence of EVAs or SCAD recurrence between npSCAD and pSCAD. Conclusion: Peripartum SCAD is associated with higher rates of dissection in the LAD compared to non-peripartum SCAD. There is no difference in prevalence of EVAs or recurrent SCAD in patients presenting with pSCAD.

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Abstract 18913: Spontaneous Coronary Artery Dissection in Women and Association With Hormonal Stressors

Circulation ◽

10.1161/circ.132.suppl_3.18913 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Lim Eng ◽

Andrew Starovoytov ◽

Milad Heydari ◽

Jacqueline Saw

Keyword(s):

Coronary Artery ◽

Hormonal Therapy ◽

Post Partum ◽

Fertility Treatment ◽

Artery Dissection ◽

Spontaneous Coronary Artery Dissection ◽

Multiple Pregnancies ◽

Coronary Artery Dissection ◽

Significant Difference

Background: Spontaneous coronary artery dissection (SCAD) is an infrequent but important cause of myocardial infarction (MI) in women. Chronic exposure to hormonal therapy, fluctuation in hormonal levels, and a history of multiple pregnancies had been postulated to predispose to SCAD. However, these were not well described in the literature. Methods: Women with SCAD who have consented and are prospectively followed in our Vancouver General Hospital SCAD registries are included in this study. Their background hormonal exposure, pregnancy, and gynaecological histories were extracted from questionnaires, clinical histories, and medical records. These were correlated to in-hospital and long-term outcomes. Results: We included 187 women with SCAD, with mean age 52.6 ± 8.7 years. The majority were Caucasian (83.4%) and 74.0% had fibromuscular dysplasia. All patients presented with MI. Mean number of pregnancy in this cohort was 2.5, with 45 (24.1%) and 25 (13.4%) having ≥4 and ≥5 pregnancies, respectively. Mean number of live births (parity) was 1.8, with 52 (27.8%) having ≥3 births, and 16 (8.6%) having ≥4 births. There were 3 post-partum SCAD (<1 year) and they were still breastfeeding. In terms of hormonal therapy, 28 (15.0%) were actively on hormonal therapy; 5 (2.7%) had prior fertility treatment, 51 (27.3%) had hormone replacement therapy (HRT), 76 (40.6%) had oral contraception, and 36 (19.3%) had gynaecological procedures. There were 107 (57.2%) post-menopausal women, and 23 (12.3%) were peri-menopausal at presentation. There was no death during acute SCAD admission, but 3 died at follow-up (mean 4.1 ± 3.9yrs), and 36 (19.3%) had recurrent SCAD. Patients actively on hormones had higher rate of recurrent SCAD (32.1% vs. 15.8%, p=0.039). There was a higher recurrent MI rate in premenopausal women during index admission (8.9% vs. 1.9%, p=0.037). There was no significant difference in in-hospital and follow-up events in women with past hormonal therapy, post-partum women, or those with parity ≥4 or gravida ≥5. Conclusion: Significant proportion of women with SCAD had exposure to hormonal therapy or had multiple pregnancies/births. Patients actively on hormonal therapy appeared to have higher recurrent SCAD events at follow-up.

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