scholarly journals ATP stress MCE in evaluating coronary microvascular spasm: a case report

2021 ◽  
Author(s):  
Liu xuebing ◽  
Chun-Mei Li ◽  
Zhang Qing-Feng
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Recovery Period ◽  
Peak Stress ◽  
Left Anterior Descending Artery ◽  
Microvascular Spasm

We report a case of coronary microvascular spasm assessed by ATP stress MCE (myocardial contrast electrocardiography). The patient had chest pain, but the coronary angiography was normal. There was apical ventricular septal perfusion delay before ATP stress, and the perfusion was significantly improved at peak stress, which was similar to the radionuclide myocardial perfusion characteristics of coronary microvascular spasm, In the recovery period, the flow spectrum resistance of the distal coronary artery of the left anterior descending artery increased compared with that before stress, which further confirmed that local coronary microvascular spasm was induced after vasodilation.

scholarly journals The value of ATP stress MCE in evaluating myocardial microvascular spasm -- a case report 1

2021 ◽  
Author(s):  
Liu xuebing ◽  
Chun-Mei Li
Keyword(s):  
Blood Flow ◽  
Case Report ◽  
Chest Pain ◽  
Coronary Artery ◽  
Recovery Period ◽  
Distal Segment ◽  
Reverse Redistribution ◽  
Clinical Value ◽  
Peak Period ◽  
Microvascular Spasm

We reported a patient with chest pain, but the coronary angiography was normal. ATP stress myocardial contrast electrocardiography(MCE) was performed. There was apical ventricular septal perfusion delay before ATP stress, and the perfusion delay areas were significantly reduced at the peak period, which was similar to the “reverse redistribution” perfusion characteristics of nuclear myocardium in coronary vasospasm, The areas of delayed perfusion in the recovery period were larger than that before stress, the increase of blood flow spectrum resistance in the distal segment of left anterior descending coronary artery and the occurrence of chest pain all showed that ATP induced myocardial microvascular spasm. The MCE perfusion characteristics and the changes of coronary spectrum had certain clinical value in the diagnosis of myocardial microvascular spasm.

scholarly journals P1487 Anomalous right coronary artery from mid left anterior descending artery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S A Fyyaz ◽  
A Katsigris ◽  
S David ◽  
K Alfakih
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Right Coronary Artery ◽  
Incidental Finding ◽  
Pain Clinic ◽  
Structural Abnormality ◽  
Single Coronary Artery ◽  
Left Anterior Descending Artery ◽  
History Of

Abstract 55-year-old male with history of transient ischaemic attack, excised gastro-intestinal stromal tumour, and osteoarthritis presented to rapid access chest pain clinic with history of atypical chest pain. There were no resting electrocardiographic changes. In accordance with NICE stable chest pain guidelines, a CT coronary angiogram was requested to further assess for any underlying coronary artery disease. This showed normal origin of left main stem (LMS) from left coronary sinus of aorta, however there was an anomalous origin of the right coronary artery (RCA) as a branch from the mid portion of left anterior descending artery (LAD). This was deemed to be an incidental finding with a benign course and not the cause of his symptoms. Coronary anomalies have a reported incidence of 1.3% at invasive coronary angiography (1), and a reported incidence of 0.014-0.066% of single coronary artery (2). Anomalous RCA usually courses from the LMS and courses between the aorta and pulmonary artery. We present an extremely rare variant of single coronary artery arising from the mid LAD without any associated congenital or structural abnormality, on CT coronary angiography (the gold standard for demonstrating coronary anatomy). This is rarely reported in the literature and is a benign coronary anomaly. Abstract P1487 Figure.

scholarly journals Multi-Modality Imaging of Coronary Artery Fistula with Giant Aneurysms

2017 ◽  
Vol 20 (5) ◽  
pp. 191
Author(s):  
Hae Won Jung ◽  
Sung Yun Lee ◽  
Yoon Cheol Shin ◽  
Woo-Ik Chang ◽  
Jun Hyun Kim ◽  
...  
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Pulmonary Artery ◽  
Surgical Repair ◽  
Coronary Artery Fistula ◽  
Chief Complaint ◽  
Giant Aneurysms ◽  
Left Anterior Descending Artery ◽  
Standard Tool

A 50-year-old woman was referred to our hospital with a chief complaint of chest pain. Coronary angiography revealed a fistula between the left anterior descending artery and pulmonary artery with giant aneurysms. Although coronary angiography is considered the standard tool to confirm a coronary artery fistula, the patient in this case underwent successful surgical repair with the aid of multi-modality imaging. 

The Potential Value of Hybrid Positron Emission Tomography/Dual-Source Computed Tomography Imaging in Coronary Bypass Surgery

2011 ◽  
Vol 14 (5) ◽  
pp. 283 ◽  
Author(s):  
Andre Plass ◽  
Maximilian Y. Emmert ◽  
Oliver Gaemperli ◽  
Hatem Alkadhi ◽  
Philipp Kaufmann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Predictive Value ◽  
Bypass Surgery ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct

<p><b>Background:</b> We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone.</p><p><b>Methods:</b> After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 � 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed.</p><p><b>Results:</b> CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect).</p><p><b>Conclusions:</b> Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.</p>

scholarly journals Downstream testing after CT coronary angiography: time for a rethink?

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001597
Author(s):  
Gareth Morgan-Hughes ◽  
Michelle Claire Williams ◽  
Margaret Loudon ◽  
Carl A Roobottom ◽  
Alice Veitch ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Communication Systems ◽  
Ct Coronary Angiography ◽  
Second Line ◽  
Recent Onset ◽  
Line Test ◽  
Artery Disease

ObjectiveWe surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) ‘recent-onset chest pain’ guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation.MethodsA prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease–Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse.Results5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0–2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively.ConclusionsWhile CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.

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