scholarly journals Myocardial ischaemia of non-obstructive origin as a cause of new onset anginal chest pain in the long COVID syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Espejo ◽  
H Mejia-Renteria ◽  
A Travieso ◽  
N Gonzalo ◽  
S Fernandez ◽  
...  
Keyword(s):  
Chest Pain ◽  
Medical Treatment ◽  
Myocardial Ischaemia ◽  
Treatment Recommendation ◽  
Endothelium Dysfunction ◽  
Funding Sources ◽  
Consensus Document ◽  
Flow Reserve ◽  
Independent Assessment ◽  
New Onset

Abstract Background New-onset chest pain occurs in around 20% of patients with long COVID syndrome (LCS). Being the vascular endothelium one of the targets of the SARS-CoV-2 virus, we hypothesized that new onset anginal symptoms in LCS could be due to endothelium dysfunction and other non-obstructive causes of myocardial ischaemia. Methods We investigated 11 consecutive patients who developed new onset anginal chest pain, suggestive of myocardial ischaemia, after documented SARS-CoV-2 infection. Intracoronary assessment included endothelium-dependent evaluation with acetylcholine testing (Ach), and endothelium-independent assessment with coronary flow reserve (CFR) and microcirculatory resistance (MR). Criteria for positiveness of these tests and medical treatment recommendation were obtained from 2019 ESC guidelines and 2020 EAPCI consensus document on ischaemia with non-obstructive coronary arteries (INOCA). Results Mean patient age was 56 years (SD ± 15); 10 (91%) were female. In the acute COVID-19 phase, 4 patients (36%) had had pulmonary infiltrates and 2 (18%) required hospitalization. Conclusive non-invasive tests were obtained in 7 (64%), showing exercise-related myocardial ischaemia in 6 (86%). Coronary angiography ruled out obstructive epicardial stenoses in all the patients. Ach testing revealed abnormal endothelium-dependent responses in 9 (82%) patients: 5 (56%) had epicardial vessel and 4 (44%) microvascular spasm. Endothelium-independent assessment was abnormal in 6 (54%) cases, with abnormal CFR in 2 (33%), abnormal MR in 2 (33) and both abnormal CFR and MR in 2 (33%) patients. The most frequent endotype was combined endothelium dependent- and independent abnormalities (6/9, 67%). Stratified medical treatment according to endotype led to significant improvement in Seattle Angina Scores for angina frequency (+22 points, p=0.013) and a notable trend towards angina stability (+25 points, p=0.093) at a mean follow-up time of 222 days. Conclusions Myocardial ischaemia of non-obstructive origin is common in patients with chest pain and LCS. Vasomotor abnormalities related to endothelial dysfunction occurred in 82% of patients, frequently associated to impaired microvascular vasodilation or high microvascular resistance. Stratified medical treatment led to significant improvement in angina stability and frequency. FUNDunding Acknowledgement Type of funding sources: None.

Sex-based impact of carotid plaque in patients with chest pain undergoing stress echocardiography

Heart ◽  
2020 ◽  
Vol 106 (23) ◽  
pp. 1819-1823
Author(s):  
Shahram Ahmadvazir ◽  
Jiwan Pradhan ◽  
Rajdeep Singh Khattar ◽  
Roxy Senior
Keyword(s):  
Chest Pain ◽  
Risk Stratification ◽  
Myocardial Ischaemia ◽  
Carotid Plaque ◽  
Stress Echocardiography ◽  
Predictive Accuracy ◽  
Outcome Data ◽  
Plaque Burden ◽  
History Of ◽  
New Onset

ObjectiveWomen with suspected angina without history of coronary artery disease (CAD) less frequently have flow-limiting stenosis (FL-CAD) and more often have microvascular disease, affecting predictive accuracy of stress echocardiography (SE) for detection of FL-CAD. We postulated that carotid plaque burden (CPB) assessment would improve detection of FL-CAD and risk stratification.MethodsConsecutive consenting patients assessed by SE on clinical grounds for new-onset chest pain also underwent simultaneous carotid ultrasound. Patients were followed for major adverse events (MAE): all-cause mortality, non-fatal myocardial infarction and unplanned revascularisation. Carotid plaque presence and burden (CPB) were assessed.ResultsAfter a mean of 2617±469 days (range 17–3740), of 591 recruited patients, 573 (97%) outcome data (314 females) were obtainable. Despite lower pretest probability of CAD in females versus males (14.9±0.8 vs 20.5±1.3, respectively, p<0.0001), prevalence of myocardial ischaemia was similar (p=0.08). Females also had lower prevalence of both carotid plaque (p<0.0001) and FL-CAD (p<0.05). CPB improved the positive predictive value of SE for detection of FL-CAD (from 34.5% to 60%) in females but not in males. Absence of CPB in females with myocardial ischaemia ruled out FL-CAD in 93% versus 57% in males. CPB was the only independent predictor of MAE (p=0.012) in females, whereas in males both SE (p<0.0001) and CPB (p=0.003) remained significant.ConclusionIn females with new-onset stable angina without a history of cardiovascular disease, CPB improved the predictive accuracy of myocardial ischaemia for flow-limiting CAD. However, CPB provided incremental risk stratification in both sexes.

Rising patients" adherence to CVD preventive treatment via medical and psychological counseling using remote technologies

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
OV Kopylova ◽  
NA Sirota ◽  
VM Yaltonsky
Keyword(s):  
Risk Factors ◽  
Medical Treatment ◽  
Healthy Lifestyle ◽  
Preventive Treatment ◽  
Control Group ◽  
Psychological Counselling ◽  
Funding Sources ◽  
Item Questionnaire ◽  
Experimental Group ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Low adherence to healthy lifestyle and CVD preventive medical treatment is a seriouse problem in lowering of CVD morbidity and mortality. Using modern medical, psychological and remote technologies may help to increase patients" adherence. Purpose To study the efficacy of medical and psychological counselling using remote technologies in rising patients" adherence to CVD preventive treatment. Methods The study included 140 patients with risk factors for cardiovascular disease (RF CVD), who were divided into two comparable groups: group of medical and psychological counselling with the use of remote technologies (n = 70) and group of control (n = 70).  The study lastet 12 months. Level of adherence was measured via standard Morisky-Green"s 4-item questionnaire as well as via additional questionnaire developed by authors for this study. Results Comparative analysis of the level of adherence in the two groups did not reveal statistically significant differences at baseline. After 12 months, the experimental group showed a statistically significant increase in adherence to preventive treatment compared with the control group (р=0,001) Conclusion(s) Medical and psychological counselling using remote technologies is an effective method for rising patients" adherence to CVD preventive medical treatment

scholarly journals Non-invasive fractional flow reserve (FFRCT) in the evaluation of acute chest pain – Concepts and first experiences

2021 ◽  
Vol 138 ◽  
pp. 109633
Author(s):  
Andreas M. Fischer ◽  
Marly van Assen ◽  
U. Joseph Schoepf ◽  
Andrew J. Matuskowitz ◽  
Akos Varga-Szemes ◽  
...  
Keyword(s):  
Chest Pain ◽  
Fractional Flow Reserve ◽  
Acute Chest Pain ◽  
Fractional Flow ◽  
Non Invasive ◽  
Flow Reserve

P6175Prediction of coronary revascularization by coronary computed tomography angiography derived fractional flow reserve - different algorithms for interpretation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K T Madsen ◽  
K T Veien ◽  
B L Noergaard ◽  
P Larsen ◽  
L Deibjerg ◽  
...  
Keyword(s):  
Chest Pain ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Coronary Revascularization ◽  
Standard Of Care ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Stable Chest Pain

Abstract Introduction Coronary CT angiography (CTA) derived fractional flow reserve (FFRct) is increasingly used for guiding referral to invasive procedures in patients with stable chest pain. However, optimal interpretation of FFRct-analysis in terms of location and threshold of applied FFRct-values is unclear. Purpose To evaluate the clinical performance of various vessel-specific physiological FFRct derived measures of ischemia for prediction of standard of care guided coronary revascularization in patients with stable chest pain and coronary artery disease as determined by coronary CTA. Methods Retrospective study in patients with stable chest pain referred for coronary angiography based on coronary CTA. Standard acquired coronary CTA data sets were transmitted for core-laboratory analysis at HeartFlow. Any FFRct value in the major coronary arteries ≥1.8 mm in diameter, including side branches, were registered. Lesions were categorized as positive for ischemia using 6 different algorithms: Lowest in vessel FFRct-value (1) ≤0.75 or (2) ≤0.80; 2 cm distal-to-lesion FFRct-value (3) ≤0.75 or (4) ≤0.80; ΔFFRct (5) ≥0.06 or a combination of 2 and 5. The personnel responsible for downstream patient management had no information regarding FFRct test results. Results A total of 172 patients were included. Revascularization was performed in 62 (35%) patients. The diagnostic performance of different FFRct algorithms for predicting standard of care guided coronary revascularization is shown in the Table. Revascularization Predictions by FFRct N=172 Diagnostic performance FFRCT false negative FFRCT false positive Values given as (%) No. of revasc vessels No. of abnormal vessels FFRCT Algorithm Sens Spec PPV NPV Acc 1 2 3 1 2 3 Distal FFRCT ≤0.75 77 68 58 84 72 12 2 0 29 5 1 Distal FFRCT ≤0.80 92 43 48 90 61 5 0 0 40 20 3 Lesion-specific FFRCT ≤0.75 68 86 74 83 80 17 3 0 12 3 0 Lesion-specific FFRCT ≤0.80 82 78 68 89 80 10 2 0 21 3 1 ΔFFRCT ≥0.06 98 36 47 98 59 1 0 0 51 19 0 Combinationa 92 54 53 92 67 5 0 0 39 12 0 aDistal FFRCT ≤0.80 and ΔFFRCT ≥0.06. Sens = sensitivity; Spec = specificity; PPV = positive predictive value; NPV = negative predictive value; Acc = accuracy; FFRCT = fractional flow reserve derived from coronary CTA; ΔFFRCT = difference between FFRCT-value immediately proximal and distal to lesion; Revasc = revascularized. Conclusion The diagnostic performance of FFRct in terms of predicting standard of care guided coronary revascularization is dependent on the applied algorithm for interpretation of the FFRct-analysis.

Left ventricular dysfunction causing ischemia in patients with patent coronary arteries

Perfusion ◽  
2017 ◽  
Vol 33 (2) ◽  
pp. 115-122
Author(s):  
Thach Nguyen ◽  
Hoang Do ◽  
Tri Pham ◽  
Loc T Vu ◽  
Marco Zuin ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
T Wave ◽  
St Depression ◽  
Wave Inversion ◽  
Group A ◽  
Group B ◽  
New Onset

Background: New onset of heart failure (HF) is an indication for the assessment of coronary artery disease. The aim of this study was to clarify the mechanistic causes of new onset HF associated with ischemic electrocardiograph (EKG) changes and chest pain in patients with patent or minimally diseased coronary arteries. Methods: Twenty consecutive patients (Group A) were retrospectively reviewed if they had an history of new onset of HF, chest pain, electrocardiographic changes indicating ischemia (ST depression or T wave inversion in at least two consecutive leads and a negative coronary angiogram [CA]) and did not require percutaneous coronary intervention or coronary artery bypass grafting. A 1:1 matched cohort (Group B) was adopted to validate the results. Results: All patients had a negative CA. The majority of subjects in Group A had a higher left ventricular end diastolic pressure (LVEDP) when compared to the control group (p<0.05). Similarly, the aortic diastolic (AOD) pressure was lower in Group A than in Group B (p<0.05). In patients with elevated LVEDP and low AOD, with a coronary perfusion pressure (CPP) <20 mmHg, deep T wave inversion in two consecutive leads were more frequently observed. When the CPP was between 20-30 mmHg, a mild ST depression were more frequently recorded (p<0.05). Conversely, when the CPP was >30 mmHg, only mild non-specific ST-T changes or normal EKG were observed. Conclusions: In patients with HF and EKG changes suggestive of ischemia in at least two consecutive leads, a lower AOD could aggravate ischemia in patients with elevated left ventricular end diastolic pressure.

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