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Tweet MS, Pellikka PA, Gulati R, Gochanour BR, Barrett-O'Keefe Z, Raphael CE, Best PJM, Hayes SN. Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes. J Am Soc Echocardiogr 2024; 37:518-529. [PMID: 38467311 DOI: 10.1016/j.echo.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/13/2024]
Abstract
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.
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Affiliation(s)
- Marysia S Tweet
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin R Gochanour
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Zachary Barrett-O'Keefe
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Claire E Raphael
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Patricia J M Best
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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Ekmejian A, Howden N, Eipper A, Allahwala U, Ward M, Bhindi R. Association between vessel-specific coronary Aggregated plaque burden, Agatston score and hemodynamic significance of coronary disease (The CAPTivAte study). IJC HEART & VASCULATURE 2024; 51:101384. [PMID: 38496257 PMCID: PMC10940135 DOI: 10.1016/j.ijcha.2024.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Background CT coronary angiography (CTCA) is a guideline-endorsed assessment for patients with stable angina and suspected coronary disease. Although associated with excellent negative predictive value in ruling out obstructive coronary disease, there are limitations in the ability of CTCA to predict hemodynamically significant coronary disease. The CAPTivAte study aims to assess the utility of Aggregated Plaque Burden (APB) in predicting ischemia based on Fractional Flow Reserve (FFR). Methods In this retrospective study, patients who had a CTCA and invasive FFR of the LAD were included. The entire length of the LAD was analyzed using semi-automated software which characterized total plaque burden and plaque morphological subtype (including Low Attenuation Plaque (LAP), Non-calcific plaque (NCP) and Calcific Plaque (CP). Aggregated Plaque Burden (APB) was calculated. Univariate and multivariate analysis were performed to assess the association between these CT-derived parameters and invasive FFR. Results There were 145 patients included in this study. 84.8 % of patients were referred with stable angina. There was a significant linear association between APB and FFR in both univariate and multivariate analysis (Adjusted R-squared = 0.0469; p = 0.035). Mean Agatston scores are higher in FFR positive vessels compared to FFR negative vessels (371.6 (±443.8) vs 251.9 (±283.5, p = 0.0493). Conclusion CTCA-derived APB is a reliable predictor of ischemia assessed using invasive FFR and may aid clinicians in rationalizing invasive vs non-invasive management strategies. Vessel-specific Agatston scores are significantly higher in FFR-positive vessels than in FFR-negative vessels. Associations between HU-derived plaque subtype and invasive FFR were inconclusive in this study.
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Affiliation(s)
- Avedis Ekmejian
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Nicklas Howden
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
| | | | - Usaid Allahwala
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Michael Ward
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
| | - Ravinay Bhindi
- Royal North Shore Hospital, Australia
- North Shore Private Hospital, Australia
- University of Sydney Northern Clinical School, Australia
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Zebic Mihic P, Arambasic J, Mlinarevic D, Saric S, Labor M, Bosnjak I, Mihaljevic I, Bilic Curcic I, Juric I. Coronary Tortuosity Index vs. Angle Measurement Method for the Quantification of the Tortuosity of Coronary Arteries in Non-Obstructive Coronary Disease. Diagnostics (Basel) 2023; 14:35. [PMID: 38201343 PMCID: PMC10795752 DOI: 10.3390/diagnostics14010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Coronary tortuosity has been recognized as a potential pathophysiological mechanism in the development of non-obstructive coronary artery disease (CAD). The aim of this study was to examine the role of two coronary tortuosity measurement methods in the detection of clinically significant coronary tortuosity. The study included 160 patients with angina symptoms and myocardial ischemia detected by cardiac stress tests in chronic settings and those diagnosed with acute coronary syndrome. After coronary angiography, tortuosity of coronary arteries was assessed by two methods, including measurement of tortuosity angles and calculating of tortuosity index. Significantly more tortuous coronary arteries were detected in the group with non-obstructive CAD (p < 0.01 for all three arteries), with significantly higher tortuosity index (TI) for all three coronary arteries in this group of patients, compared to patients with obstructive CAD. The highest TI for LCX was found in patients with lateral ischemia (p < 0.001) and for LAD in patients with anterior ischemia (p < 0.001). When measured by the angle method, the only association was found between LCX tortuosity and lateral ischemia (OR 4.9, p = 0.046). In conclusion, coronary tortuosity represents a pathophysiological mechanism for myocardial ischemia in non-obstructive CAD. The coronary tortuosity index could be a reliable and widely applicable tool for the quantification of coronary tortuosity.
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Affiliation(s)
- Petra Zebic Mihic
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia; (P.Z.M.); (I.J.)
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jerko Arambasic
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia; (P.Z.M.); (I.J.)
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Drazen Mlinarevic
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia; (P.Z.M.); (I.J.)
| | - Sandra Saric
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia; (P.Z.M.); (I.J.)
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marina Labor
- Cancer and Lung Health Care Unit, University Hospital Linköping, 58185 Linköping, Sweden
| | - Ivica Bosnjak
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia; (P.Z.M.); (I.J.)
| | - Ivica Mihaljevic
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nuclear Medicine, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Ines Bilic Curcic
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Endocrinology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Iva Juric
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia; (P.Z.M.); (I.J.)
- Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, 31000 Osijek, Croatia
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Mihai DE, Delcea C, Buzea CA, Balan S, Dan GA. Coronary artery tortuosity and mid-term all-cause mortality of patients with ischemia and non-obstructive coronary arteries. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2023; 61:202-211. [PMID: 37540841 DOI: 10.2478/rjim-2023-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Background: Coronary artery tortuosity (CAT) is a frequently encountered angiographic feature of patients with ischemia and non-obstructive coronary arteries (INOCA). However, there is limited data regarding the possible correlation between CAT and all-cause mortality in these patients. Aim: To assess the survival prognostic implications of CAT in INOCA patients and the predictors of all-cause mid-term mortality of these patients. Methods: All consecutive INOCA patients, with preserved ejection fraction evaluated for clinical ischemia by coronary angiography in our department between January 2014 and December 2020 were considered for inclusion. Patients with epicardial coronary artery stenosis ≥ 50%, severe pulmonary hypertension, or decompensated extra cardiac disease were excluded. Eleid classification was used for CAT severity characterization. We assessed all-cause mortality in January 2023. Results: Our sample included 328 INOCA patients. 15.54% died during the mean follow-up of 3.75 ± 1.32 years. 79.88% had CAT. CAT patients were older (65.10±9.09 versus 61.24±10.02 years, p=0.002), and more often female (67.18% versus 31.82%, p<0.001). CAT was inversely correlated with all-cause mid-term mortality (OR 0.35, 95%CI 0.16 - 0.77, p=0.01). CAT severity had no impact on survival. In CAT patients the initial multivariable analysis identified NT-proBNP levels (HR 3.96, p=0.01), diabetes mellitus (DM) (HR 4.76, p=0.003), and atrial fibrillation (HR 2.68, p=0.06) as independent predictors of all-cause mortality. In the final analysis, NT-proBNP and DM were the main independent predictors of survival. Conclusions : In our INOCA cohort, CAT patients were older and more likely female. CAT was inversely correlated with mid-term all-cause mortality. NT-proBNP and DM were the main independent predictors of mortality of CAT patients.
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Affiliation(s)
| | - Caterina Delcea
- 1Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
- 2"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cătălin Adrian Buzea
- 1Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
- 2"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Sabina Balan
- 1Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - Gheorghe Andrei Dan
- 1Cardiology Department, Colentina Clinical Hospital, Bucharest, Romania
- 2"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Patel H, Diem D, Keyes P, Supariwala AA, Syed S. Coronary Artery Tortuosity Found in a Marathon Runner. Cureus 2023; 15:e39849. [PMID: 37404405 PMCID: PMC10314825 DOI: 10.7759/cureus.39849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Coronary artery tortuosity (CAT) is an anatomical anomaly in which the coronary arteries contain kinks or coils. It is usually found incidentally in elderly patients with long-standing uncontrolled hypertension. This case illustrates a 58-year-old female marathon runner who was found to have CAT, originally presenting with chest pain, hypotension, presyncope, and a severe cramping sensation in her legs.
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Affiliation(s)
- Humail Patel
- Internal Medicine, Northwell Health, Manhasset, USA
| | | | | | | | - Sarah Syed
- Cardiology, Northwell Health, Bay Shore, USA
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Liu WJ, Dhuromsingh M, He XW, Xie Y, Liu XL, Wang HJ, Zeng HS. Relationship between Coronary Artery Tortuosity and Cardiorespiratory Fitness in Patients without Obstructed Coronaries. Curr Med Sci 2022; 42:941-948. [PMID: 36245033 DOI: 10.1007/s11596-022-2656-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to analyze the relationship between cardiorespiratory fitness (CRF) and the increasing severity of coronary artery tortuosity (CAT) in patients with non-stenosed coronaries. METHODS A total of 396 patients who underwent coronary angiography and cardiopulmonary exercise testing (CPET) between August 2020 and July 2021 were included in this single-center retrospective study after excluding patients with significant coronary artery disease (≥50% stenosis). Patients were divided into two groups: no or mild coronary artery tortuosity (N/M-CAT) and moderate to severe coronary artery tortuosity (M/S-CAT) and laboratory electrocardiographic, echocardiographic, and CPET parameters were compared between two groups. RESULTS M/S-CAT was found in 46.9% of the study participants, with 66.7% being women. M/S-CAT was significantly associated with advanced age (P=0.014) and females (P=0.001). Diastolic dysfunction parameters, E velocity (P=0.011), and E/A ratio (P=0.004) also revealed significant differences between the M/S-CAT group and N/M-CAT group. VO2@peak (1.22±0.39 vs. 1.07±0.39, P<0.01) and VO2@AT (0.77±0.22 vs. 0.71±0.21, P=0.017) were significantly lower in the M/S-CAT group than in the N/M-CAT group. Multivariate logistic regression analysis identified females (OR=0.448; 95% CI, 0.296-0.676; P=0.000) and E/A ratio (OR=0.307; 95% CI, 0.139-0.680; P=0.004) to be independent risk factors of M/S-CAT and showed no association of CPET parameters to M/S-CAT. CONCLUSION The results indicate that increasing severity of CAT is strongly associated with female gender and E/A ratio and is not directly correlated with decreasing CRF. Further research with a larger patient population and a longer follow-up time is required to fully comprehend the impact of CAT on CRF.
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Affiliation(s)
- Wan-Jun Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Menaka Dhuromsingh
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xing-Wei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yang Xie
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Lei Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Jie Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - He-Song Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Impact of coronary artery tortuosity in ischemic and non-ischemic cardiovascular pathology. ACTA ACUST UNITED AC 2021; 59:119-126. [PMID: 33544530 DOI: 10.2478/rjim-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Indexed: 11/20/2022]
Abstract
The aim of this paper was to review based on the existing literature the impact of coronary artery tortuosity on coronary pathology. Primarily, an attempt was made to establish the implication of coronary tortuosity as a physio-pathological mechanism of inducing ischemia in patients with non-obstructive coronary artery disease (CAD). Because the prevalence of tortuosity is higher in severe hypertensive patients, a second purpose of this paper was to review this association by understanding the physio-pathological processes and fluid dynamics in hypertrophic heart. Particularly, the effect of coronary tortuosity on systolic function with reference to longitudinal function and ventricular relaxation was addressed. Finally, the technical difficulties imposed by coronary tortuosity to percutaneous coronary interventions were discussed.
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Konigstein M, Ben-Yehuda O, Redfors B, Mintz GS, Madhavan MV, Golomb M, McAndrew T, Zhang Z, Kandzari DE, Hermiller JB, Leon MB, Stone GW. Impact of Coronary Artery Tortuosity on Outcomes Following Stenting: A Pooled Analysis From 6 Trials. JACC Cardiovasc Interv 2021; 14:1009-1018. [PMID: 33640388 DOI: 10.1016/j.jcin.2020.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The authors sought to determine whether coronary artery tortuosity negatively affects clinical outcomes after stent implantation. BACKGROUND Coronary artery tortuosity is a common angiographic finding and has been associated with increased rates of early and late major adverse events after balloon angioplasty. METHODS Individual patient data from 6 prospective, randomized stent trials were pooled. Outcomes at 30 days and 5 years following percutaneous coronary intervention of a single coronary lesion were analyzed according to the presence or absence of moderate/severe vessel tortuosity, as determined by an angiographic core laboratory. The primary endpoint was target vessel failure (TVF) (composite of cardiac death, target vessel-related myocardial infarction [TV-MI], or ischemia-driven target vessel revascularization [ID-TVR]). RESULTS A total of 6,951 patients were included, 729 of whom (10.5%) underwent percutaneous coronary intervention in vessels with moderate/severe tortuosity. At 30 days, TVF was more frequent in patients with versus without moderate/severe tortuosity (3.8% vs. 2.4%; hazard ratio [HR]: 1.64; 95% confidence interval [CI]: 1.09 to 2.46; p = 0.02), a difference driven by a higher rate of TV-MI. At 5 years, TVF remained increased in patients with moderate/severe tortuosity (p = 0.003), driven by higher rates of TV-MI (p = 0.003) and ID-TVR (p = 0.01). Definite stent thrombosis was also greater in patients with versus without moderate/severe tortuosity (1.9% vs. 1.0%; HR: 1.86; 95% CI: 1.02 to 3.39; p = 0.04). After adjustment for baseline covariates, moderate/severe vessel tortuosity was independently associated with TV-MI and ID-TVR at 5 years (p = 0.04 for both). CONCLUSIONS Stent implantation in vessels with moderate/severe coronary artery tortuosity is associated with increased rates of TVF due to greater rates of TV-MI and ID-TVR.
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Affiliation(s)
- Maayan Konigstein
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Tel Aviv-Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Division of Cardiology, University of California - San Diego, San Diego, California, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Mahesh V Madhavan
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Mordechai Golomb
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | | | | | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Khosravani-Rudpishi M, Akhavan-Khaleghi N, Hosseinsabet A. Two-dimensional speckle-tracking echocardiographic evaluation of the longitudinal deformation of the left ventricular myocardium in patients with severe coronary artery tortuosity. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:467-474. [PMID: 29683198 DOI: 10.1002/jcu.22597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/15/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Coronary artery tortuosity (CAT) is an anatomical condition in which epicardial coronary arteries have abnormal curves or spiral courses. Although correlated with higher rates of positive stress test, its effects on the myocardial function remain to be clearly defined. METHODS We included in this cross-sectional study and evaluated with 2D speckle-tracking echocardiography 40 consecutive patients admitted to our hospital for selective coronary angiography which showed severe CAT without significant epicardial coronary artery stenosis, and 40 consecutive subjects matched for age, hypertension, and diabetes in whom selective coronary angiography showed neither CAT nor significant epicardial coronary artery stenosis. RESULTS Systolic strain, strain rate, and early and late diastolic strain rates were not significantly different between the 2 groups, even after adjustment for potential confounding variables. CONCLUSION The 2D speckle-tracking echocardiography-derived indices of longitudinal deformation of the left ventricular myocardium were not significantly different between the patients with severe CAT and controls.
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Affiliation(s)
| | | | - Ali Hosseinsabet
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, I.R., Iran
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Hensel KO, Roskopf M, Wilke L, Heusch A. Intraobserver and interobserver reproducibility of M-mode and B-mode acquired mitral annular plane systolic excursion (MAPSE) and its dependency on echocardiographic image quality in children. PLoS One 2018; 13:e0196614. [PMID: 29746603 PMCID: PMC5944962 DOI: 10.1371/journal.pone.0196614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/15/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mitral annular plane systolic excursion (MAPSE) is an increasingly used echocardiography technique to assess left ventricular (LV) function. However, reproducibility and dependence on echocardiographic image quality for MAPSE in pediatric patients have not been studied to date. METHODS We analyzed 284 transthoracic echocardiograms performed on consecutive normotensive children without structural heart disease (mean age 12.6±3.1 years, 50.4% female). B-mode and M-mode derived MAPSE measurements were performed and analyzed regarding inter- and intraobserver reliability and the influence of echocardiographic image quality. RESULTS Overall, MAPSE measurements were highly reproducible with only minor bias. Both inter- and intraobserver reliability were significantly better for M-mode derived MAPSE (p<0.001). Echocardiographic image quality did not significantly influence M-mode MAPSE reproducibility (p>0.235). In contrast, B-mode lateral MAPSE was significantly better reproducible in optimal image quality (-0.07±1.04) when compared to suboptimal echocardiographic images (0.42±1.59, p<0.001). Moreover, poor quality images yielded significantly lower M-mode MAPSE values (14.3±2 mm) than near-optimal (15.2±1.9 mm, p<0.001) or optimal images (15.1±2.2 mm, p = 0.006). CONCLUSION Echocardiographic image quality essentially has a negligible effect on MAPSE reproducibility and measurements. Consequently, MAPSE is a robust echocardiographic parameter with convincing reproducibility for the assessment of LV function in children-even in patients with substandard imaging conditions.
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Affiliation(s)
- Kai O. Hensel
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
- University of Cambridge, Addenbrooke’s University Hospital, Department of Pediatrics, Cambridge, United Kingdom
- * E-mail:
| | - Markus Roskopf
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
| | - Lucia Wilke
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
| | - Andreas Heusch
- HELIOS University Medical Center Wuppertal, Children’s Hospital, Department of Pediatrics, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Wuppertal, Germany
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Ferencik M. About the twists and turns: Relationship of coronary artery geometry and atherosclerosis. J Cardiovasc Comput Tomogr 2018; 12:261-262. [PMID: 29759894 DOI: 10.1016/j.jcct.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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