Increased basal tone and hyperresponsiveness to acetylcholine and ergonovine in spasm related coronary arteries in patients with variant angina: basal coronary artery tone in patients with variant angina

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

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Congenital Left Main Coronary Artery to Coronary Sinus Fistula

The Heart Surgery Forum ◽

10.1532/hsf98.20101085 ◽

2011 ◽

Vol 14 (4) ◽

pp. 255 ◽

Cited By ~ 4

Author(s):

Fotios A. Mitropoulos ◽

Meletios A. Kanakis ◽

Periklis A. Davlouros ◽

George Triantis

Keyword(s):

Coronary Artery ◽

Coronary Arteries ◽

Coronary Sinus ◽

Left Main Coronary Artery ◽

Coronary Artery Fistula ◽

Left Main ◽

Coronary Fistula ◽

Excellent Outcome ◽

Surgical Ligation ◽

Congenital Coronary Artery Fistula

Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgical ligation of the fistula and had an excellent outcome.

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Coronary artery embolism in a patient with mechanical heart valve and normal coronary arteries (clinical case)

Practical medicine ◽

10.32000/2072-1757-2019-2-153-157 ◽

2019 ◽

Vol 17 (2) ◽

pp. 153-157

Author(s):

A. Z. Sharafeev ◽

◽

A. F. Khalirakhmanov ◽

A. I. Alkhazurov ◽

E. A. Gaziev ◽

...

Keyword(s):

Coronary Artery ◽

Heart Valve ◽

Coronary Arteries ◽

Clinical Case ◽

Mechanical Heart Valve ◽

Normal Coronary Arteries ◽

Artery Embolism ◽

Coronary Artery Embolism

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Gender Differences in Non-Obstructive Coronary Artery Disease

Current Pharmaceutical Design ◽

10.2174/1381612826666201012163845 ◽

2020 ◽

Vol 26 ◽

Author(s):

Maria Bergami ◽

Marialuisa Scarpone ◽

Edina Cenko ◽

Elisa Varotti ◽

Peter Louis Amaduzzi ◽

...

Keyword(s):

Coronary Artery Disease ◽

Gender Differences ◽

Heart Disease ◽

Coronary Artery ◽

Ischemic Heart Disease ◽

Coronary Arteries ◽

Obstructive Coronary Artery Disease ◽

Ischemic Heart ◽

Current Evidence ◽

Artery Disease

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

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Quantitative evaluation and comparison of coronary artery characteristics by 3D coronary volume reconstruction

Scientific Reports ◽

10.1038/s41598-020-80928-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongcheol Kim ◽

Jonathan James Hyett Bray ◽

Benjamin Waterhouse ◽

Alexander Gall ◽

Georgia May Connolly ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Intraclass Correlation ◽

Quantitative Coronary Angiography ◽

Volume Estimation ◽

Diabetic Patients ◽

Volume Reconstruction ◽

3 Dimensional ◽

Inter Observer Variability

AbstractNon-atherosclerotic abnormalities of vessel calibre, aneurysm and ectasia, are challenging to quantify and are often overlooked in qualitative reporting. Utilising a novel 3-dimensional (3D) quantitative coronary angiography (QCA) application, we have evaluated the characteristics of normal, diabetic and aneurysmal or ectatic coronary arteries. We selected 131 individuals under 50 years-of-age, who had undergone coronary angiography for suspected myocardial ischaemia between 1st January 2011 and 31st December 2015, at the Bristol Heart Institute, Bristol, UK. This included 42 patients with angiographically normal coronary arteries, 36 diabetic patients with unobstructed coronaries, and 53 patients with abnormal coronary dilatation (aneurysm and ectasia). A total of 1105 coronary segments were analysed using QAngio XA 3D (Research Edition, Medis medical imaging systems, Leiden, The Netherlands). The combined volume of the major coronary arteries was significantly different between each group (1240 ± 476 mm3 diabetic group, 1646 ± 391 mm3 normal group, and 2072 ± 687 mm3 abnormal group). Moreover, the combined coronary artery volumes correlated with patient body surface area (r = 0.483, p < 0.01). Inter-observer variability was assessed and intraclass correlation coefficient of the total coronary artery volume demonstrated a low variability of 3D QCA (r = 0.996, p < 0.001). Dedicated 3D QCA facilitates reproducible coronary artery volume estimation and allows discrimination of normal and diseased vessels.

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Prognostic value of non-invasive coronary artery flow velocity assessment in elderly patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.097 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Kalinina ◽

A Zagatina ◽

N Zhuravskaya ◽

D Shmatov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Elderly Patients ◽

Flow Velocity ◽

Coronary Arteries ◽

Coronary Flow ◽

Prognostic Value ◽

Area Under Curve ◽

Left Coronary Artery ◽

Maximal Velocity

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a high prevalence of coronary artery disease (CAD) in the elderly population. However, symptoms of CAD are often non-specific. Dyspnoe, non-anginal pains are among the main symptoms in older patients. Exercise tests are of limited feasibility in these patients, due to neuro-muscular weakness, physical deconditioning, and orthopaedic limitations. Pharmacological tests often are contraindicated in a substantial percentage of elderly patients. Some recent studies indicate using local flow acceleration during routine echocardiography has prognostic potential for coronary artery assessments without stress testing. The aim of the study was to define the prognostic value of coronary artery ultrasound assessment in patients ≥75 years old. Methods This is a prospective cohort study. Patients ≥ 75 years old who underwent routine echocardiography with additional scans for coronary arteries over a period of 24 months were included in the study. The study group consisted of 80 patients aged 75-90 years (56 women; mean age 79 ± 4). Initial exams were performed for other reasons, primarily for arterial hypertension. Fifteen patients had known CAD. Death, non-fatal myocardial infarction (MI), and revascularization were defined as major adverse cardiac events (MACE). All patients were followed up with at a median of 32 months. Results There were 34 patients with high local velocities in the left coronary artery. Eight deaths, two non-fatal myocardial infarctions occurred, and 13 revascularizations were performed. With a ROC analysis, a coronary flow velocity >110 cm/s was the best predictor for risk of death (area under curve 0.84 [95% CI 0.74–0.92]; sensitivity 75%; specificity 88%). Only the maximal velocity in proximal left-sided coronary arteries was independently associated with death (HR 1.03, 95% CI 1.01; 1.05; p < 0.002), or death/MI (HR 1.03, 95% CI 1.01; 1.04; p < 0.0001). The cut-off value of 66 cm/s was a predictor of all MACE (area under curve 0.87 [95% CI 0.77–0.94]; sensitivity 80%; specificity 86%). Any causes of death or MI occurred more frequently in patients with velocities of >66 cm/s (27% vs. 2%; p < 0.002). The rates of MACE were 58.0% vs. 2%; p < 0.0000001, respectively. Conclusion The analysis of coronary flow in the left coronary artery during echocardiography can be used as a predictor of outcomes in elderly patients. Maximal velocities in proximal left-sided coronary arteries is independently associated with further death or myocardial infarction.

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