scholarly journals Exercise-Induced Abnormalities of Regional Myocardial Deformation in Anomalous Aortic Origin of the Right Coronary Artery

2020 ◽  
Vol 11 (6) ◽  
pp. 712-719
Author(s):  
Edem Binka ◽  
Ni Zhao ◽  
Scott Wood ◽  
Stefan L. Zimmerman ◽  
W. Reid Thompson
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Exercise Stress ◽  
Inferior Wall ◽  
Regional Wall ◽  
The Right

Aims: Congenital coronary artery anomalies are uncommon and may result in sudden death. Management of asymptomatic patients with anomalous aortic origin of the right coronary artery (AAORCA) remains controversial with a lack of evidence to guide decision-making. We hypothesized that patients with AAORCA may have exercise-inducible ischemia detectable as abnormalities in regional myocardial deformation on exercise stress echocardiography (ESE). Methods: We reviewed clinical data, computed tomography angiography, and treadmill ESE from 33 AAORCA patients (21 unoperated, 12 operated) and 11 controls. Regional wall motion on ESE was visually assessed. Doppler tissue imaging was done pre and post exercise to evaluate regional myocardial wall deformation. The post- to pre-exercise time to peak systolic strain corrected for heart rate ratio (TPScR) for the left ventricular inferior and anterior walls of AAORCA patients was compared to controls. Results: No regional wall motion abnormalities were noted. The TPScR of the inferior wall was higher in unoperated (0.96 ± 0.41) but not operated (0.84 ± 0.28) AAORCA patients compared to controls (0.76 ± 0.18, P = .03 vs .23, respectively). There was no significant difference in TPScR of the anterior wall between unoperated patients and controls ( P = .08). Conclusion: In some AAORCA patients undergoing ESE, TPScR of the left ventricular inferior wall is elevated, suggestive of ischemia induced by exercise in myocardium supplied by the right coronary artery. Further work is needed to understand the potential role of this finding in risk assessment.

scholarly journals Editor’s Choice- Pathophysiology, diagnosis and management of MINOCA: an update

2018 ◽  
Vol 8 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Giancarla Scalone ◽  
Giampaolo Niccoli ◽  
Filippo Crea
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall ◽  
Diagnosis And Management ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome with different causes, characterised by clinical evidence of myocardial infarction with normal or near-normal coronary arteries on angiography. Its prevalence ranges between 5% and 25% of all myocardial infarction. The prognosis is extremely variable, depending on the cause of MINOCA. The key principle in the management of this syndrome is to clarify the underlying individual mechanisms to achieve patient-specific treatments. Clinical history, electrocardiogram, cardiac enzymes, echocardiography, coronary angiography and left ventricular angiography represent the first level diagnostic investigations to identify the causes of MINOCA. Regional wall motion abnormalities at left ventricular angiography limited to a single epicardial coronary artery territory identify an ‘epicardial pattern’whereas regional wall motion abnormalities extended beyond a single epicardial coronary artery territory identify a ‘microvascular pattern’. The most common causes of MINOCA are represented by coronary plaque disease, coronary dissection, coronary artery spasm, coronary microvascular spasm, Takotsubo cardiomyopathy, myocarditis, coronary thromboembolism, other forms of type 2 myocardial infarction and MINOCA of uncertain aetiology. This review aims at summarising the diagnosis and management of MINOCA, according to the underlying physiopathology.

scholarly journals 1680 Left ventricular filling pressure assessment with exercise stress echocardiography in patients with non-valvular atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Lara-Breitinger ◽  
M W Ullah ◽  
C L Luong ◽  
R Padang ◽  
J K Oh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Functional Capacity ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Exercise Stress ◽  
Regional Wall ◽  
Ventricular Filling

Abstract Background Noninvasive parameters of LV filling pressure (E/e’) and pulmonary pressures (RVSP) by Doppler echocardiography correlate with functional capacity and outcome in sinus rhythm (SR). Their role in AF is less clear. Elevated left ventricular filling pressures (E/e’) and pulmonary artery systolic pressures (PASP) by Doppler stress echocardiography correlate with impaired functional capacity in patients in sinus rhythm (SR). However, there is limited data in atrial fibrillation (AF). Purpose The aim of this study was to delineate the characteristics of patients with AF referred for exercise stress echocardiography and determine the prevalence and significance of E/e’ and PASP elevations in AF. Methods Subjects were patients referred for exercise treadmill stress echocardiography (n= 14,937) and underwent regional wall motion assessment, Doppler assessment of mitral inflow (E) and early tissue relaxation (e’) velocities and PASP at rest and immediately following maximum symptom limited exercise. Exclusion criteria included significant valvular heart disease (moderate or greater stenosis and/or regurgitation of any cardiac valve or previous valve repair or replacement) (1%), congenital heart disease (<1%) or refusal to participate in research (<1%). Results Patients with AF (n = 310, 2%) were older (71 ± 10 vs 59 ± 13 years, p < 0.001). While resting blood pressure was similar, resting heart rates were higher in AF (80 ± 17 bpm vs 73 ± 13 bpm, p < 0.0001). AF patients achieved lower workloads (6.4 ± 2.4 METS vs 9 ± 2.4 METS, p < 0.001) with lower peak double products (22336 ± 6677 vs 25148 ± 5438, p < 0.001). Rates of resting (27% vs 10%, p < 0.0001) and exercise-induced (37% vs 20%, p < 0.0001) regional wall motion abnormalities were higher in AF. Mean E/e’ was higher in AF at rest (12 ± 5 vs 9 ± 3, p < 0.001) and with exercise (12 ± 5 vs 10 ± 4, p < 0.001), with a higher percentage of patients in AF having E/e’ ≥15 at rest (20% vs 6% in SR, p= <0.001) and with exercise in (23% vs 8%, p < 0.001). PASP was higher in AF at rest (33 ± 8 mm Hg vs 28 ± 6 mm Hg, p < 0.001) and with exercise (48 ± 12 vs 42 ± 11, p < 0.001) compared to SR. E/e’ correlated with exercise capacity in AF and in SR, with an E/e’ cutoff of 11.7 that was best predictive of impaired functional capacity (< 5 METS in women and < 7 METS in men). Conclusions Abnormalities of E/e’ and PASP are more prevalent in patients with AF and correlate with impaired functional capacity. In patients with AF, a medial E/e’ ratio of ≥ 12 immediately following exercise is best associated with impaired functional capacity.

scholarly journals Congenital Absence of Right Coronary Artery without any other Associated Anomalies - A Case Report

1970 ◽  
Vol 6 (1) ◽  
pp. 45-47
Author(s):  
Syed Dawood Md Taimur ◽  
Saidur Rahman Khan ◽  
M Maksumul Haq ◽  
Mahbub Mansur ◽  
Md Harisul Haque ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Tolerance Test ◽  
Congenital Absence ◽  
Single Coronary Artery ◽  
Inferior Wall ◽  
Exercise Tolerance Test ◽  
Angiographic Findings

A 54 years gentleman presented with central compressive type of chest pain. He was newly diagnosed diabetic, dyslipidaemic. His ECG (electrocardiogram) showed features of anterior and inferior wall ischemia. Echocardiography revealed presence of regional wall motion abnormality. Exercise tolerance test was positive for provocable myocardial ischemia. Angiographic findings includes single coronary artery with congenital absence of RCA (Right coronary artery). Right coronary arterial territory was supplied by the terminal part of left circumflex coronary artery. Key Words: Congenital coronary; Right coronary artery (RCA); Single Coronary Artery. DOI: 10.3329/uhj.v6i1.7195University Heart Journal Vol.6(1) 2010 pp.45-47

scholarly journals Successful Revascularization to Right Coronary Artery by Percutaneous Coronary Intervention after Endovascular Therapy for Leriche Syndrome

2014 ◽  
Vol 7 ◽  
pp. CCRep.S13551 ◽  
Author(s):  
Takeshi Niizeki ◽  
Kazuyoshi Kaneko ◽  
Shigeo Sugawara ◽  
Toshiki Sasaki ◽  
Yuichi Tsunoda ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Endovascular Therapy ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Leriche Syndrome ◽  
Percutaneous Coronary ◽  
The Right

A 69-year-old man with effort angina was admitted to our institution. Echocardiography showed poor left ventricular systolic function with akinesis of the anterior wall and severe hypokinesis of the inferior wall. We performed coronary angiography, which revealed two diseased vessels including chronic total occlusion in the left anterior descending artery and severe stenosis in the right coronary artery (RCA). In addition, aortography revealed aortoiliac occlusive disease known as Leriche syndrome. As the patient's symptom was stable, we first planned to perform endovascular therapy (EVT) for Leriche syndrome to make a route for intra-aortic balloon pumping. We prepared a bi-directional approach from bi-femoral arteries and a left brachial artery. The guidewire was passed through the occlusive area using the retrograde approach. The self-expanding stents were deployed by a kissing technique. At one week after EVT, a 6Fr sheath was inserted from the right radial artery and an intra-aortic balloon pump was successfully inserted through the right femoral artery for percutaneous coronary intervention (PCI) to the RCA. Two drug-eluting stents were successfully deployed to RCA after using an atherectomy device (rotablator). We reported the case as a successfully performed PCI to the RCA after EVT for Leriche syndrome.

scholarly journals Global Myocardial Work in Coronary Artery Disease Patients Without Regional Wall Motion Abnormality: Correlation With Gensini Score

2021 ◽  
Author(s):  
Miao Li ◽  
Yuhao Wang ◽  
Lin Li ◽  
Wenfang Wu ◽  
Pingyang Zhang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Wall Motion Abnormality ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall Motion Abnormality ◽  
Gensini Score ◽  
Regional Wall ◽  
Artery Disease

Abstract PurposeThis study aimed to investigate global myocardial work (GMW), derived from non-invasive left ventricular (LV) pressure-strain loops (PSLs) in coronary artery disease (CAD) patients without regional wall motion abnormality (RWMA), and explored the relationship between GMW and severity of CAD using Gensini score (GS) . Methods120 patients prepared for coronary angiography (CAG) who had left ventricular ejection fraction≥55%, no resting RWMA in two-dimensional echocardiography were enrolled. Global longitudinal strain (GLS), GMW parameters (including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global myocardial work efficiency (GWE)) were quantified. The severity of coronary lesions was evaluated by GS system based on CAG findings. We divided CAG-confirmed CAD patients into three subgroups according to the tertiles of GS: low 0<GS 16, mid 16<GS 38, and high GS>38. ResultsCAD patients showed a significantly reduced GLS and GWE, but an increased GWW. GLS, GWE, GWI and GCW were significantly decreased in the high-GS group while GWW was increased. GLS, GWE, GWI and GCW was negatively correlated with the GS, GWW was positively correlated with GS. Multivariate regression analysis showed that GWE was the independent factor of predicting coronary stenosis. ROC analysis demonstrated that GWE was the most powerful predictor of high-GS and was superior to GLS. GWE under 91% had the optimal sensitivity and specificity for identifying high-GS. ConclusionThe proposed GWE, which outperformed the GLS, showed the optimal performance and could be considered as a potential predictive indicator to detect severe coronary disease in non-RWMA CAD patients.

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