Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes - 02/05/24
, Patricia A. Pellikka, MD a, Rajiv Gulati, MD, PhD a, Benjamin R. Gochanour, MS b, Zachary Barrett-O’Keefe, PhD, RDCS a, Claire E. Raphael, MBBS, PhD a, Patricia J.M. Best, MD a, Sharonne N. Hayes, MD aAbstract |
Background |
The etiology and significance of coronary artery tortuosity (TCA) among patients with spontaneous coronary artery dissection (SCAD) are unknown. The aim of this prospective imaging cohort study was to report echocardiographic findings and evaluate whether TCA correlates with cardiac anatomy and function among patients with SCAD. Comorbidities including fibromuscular dysplasia (FMD) and outcomes were also assessed.
Methods |
TCA was determined on coronary angiography performed during the diagnosis of SCAD, and cardiac structure and function were evaluated using prospective comprehensive echocardiography.
Results |
Among 116 patients with SCAD, the mean age at echocardiography was 50.8 ± 8.8 years, a median of 10.9 months after SCAD. Sixty-two patients (53.4%) had FMD, 41 (35.3%) had histories of hypertension, and 17 (14.8%) were hypertensive during echocardiography. Most patients (n = 78 [69%]) had normal left ventricular geometry with normal median ejection fraction (61%; interquartile range, 56% to 64%) and normal global longitudinal strain (−22.2%; interquartile range, −24.0% to −19.9%). Fifteen patients (13.4%) had diastolic dysfunction that was associated with hypertension at the time of echocardiography. Patients with TCA (n = 96 [82.8%]) were older (mean age, 52.1 ± 8.0 vs 44.7 ± 9.9 years; P < .001) with a higher prevalence of FMD (59.4% vs 25%, P = .007) but a similar prevalence of hypertension (35% vs 35%, P > .99) compared with patients without TCA. Across the age range (31.5 to 66.9 years), each decade of age was associated with an approximately 0.89-unit increase in coronary tortuosity score (P < .0001). Echocardiographic parameters were not significantly different between the two groups. Median follow-up duration was 4.4 years (95% CI, 3.8 to 5.2 years). The Kaplan-Meier 3-year SCAD recurrence rate was 9.4% (95% CI, 3.7% to 14.8%). There were no deaths.
Conclusions |
The majority of patients with SCAD had normal or near normal echocardiographic results, including global longitudinal strain, with no differences according to TCA. However, patients with SCAD with TCA were older, with a higher prevalence of FMD.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Echocardiographic parameters were no different among patients with histories of SCAD and TCA compared with those with histories of SCAD without TCA. CI, Cardiac index; CO, cardiac output; LA, left atrial; LV, left ventricular; RA, right atrial.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Among patients with SCAD, TCA is associated with FMD and older age. |
• | All patients with SCAD with mid ascending aortic dimension > 40 mm had TCA. |
• | Most patients with SCAD had normal or near normal echocardiographic findings. |
• | TCA did not correlate with specific echocardiographic parameters. |
Keywords : Spontaneous coronary artery dissection, Fibromuscular dysplasia, Coronary artery tortuosity, Global longitudinal strain, Echocardiography, Myocardial infarction, Acute coronary syndrome, Women
Abbreviations : 2D, FMD, GLS, IQR, LVEF, SCAD, TCA
Plan
| Dr. Tweet received a grant (HD65987) from the National Institutes of Health Building Interdisciplinary Careers in Women’s Health Scholars Program during the conduct of this study and receives current grant support from the National Institutes of Health Mentored Patient-Oriented Research Career Award (1K23HL155506). The study echocardiograms were supported by the Mayo Clinic Department of Cardiovascular Medicine prospective award; the Mayo Clinic Department of Cardiovascular Medicine, Division of Ischemic Heart Disease award; and nonfinancial support for ultrasound enhancing agent from Bracco Diagnostics. The Mayo Clinic SCAD Research study staff were supported by SCAD Research, Inc. |
|
| Thor Edvardsen, MD, served as guest editor for this report. |
Vol 37 - N° 5
P. 518-529 - mai 2024 Retour au numéro
Article précédent
- Modeling the Relationship Between Diastolic Phenotype and Outcomes in Pediatric Hypertrophic Cardiomyopathy
- Minh B. Nguyen, Maelys Venet, Chun-Po Steve Fan, Andreea Dragulescu, Craig G. Rusin, Luc L. Mertens, Seema Mital, Olivier Villemain
- Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival
- Ahmed El Shaer, Alejandra A. Chavez Ponce, Mays T. Ali, Didem Oguz, Sorin V. Pislaru, Vuyisile T. Nkomo, Ratnasari Padang, Mackram F. Eleid, Mayra Guerrero, Guy S. Reeder, Charanjit S. Rihal, Mohamad Alkhouli, Jeremy J. Thaden
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?