Prevalence of Coronary Vasomotor Disorders in Patients With Angina and Nonobstructive Coronary Arteries: A Sydney Experience.

Autor: Rehan R; Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Concord Hospital, University of Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Electronic address: https://twitter.com/RajanRehan23., Wong CCY; Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Concord Hospital, University of Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Cooke C; Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia., Weaver J; Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Jain P; Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Adams M; Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Ng MKC; Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia., Yong ASC; Department of Cardiology, Concord Hospital, University of Sydney, NSW, Australia; Faculty of Medicine, Health, and Human Sciences, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia. Electronic address: andy.yong@sydney.edu.au.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2024 Sep; Vol. 33 (9), pp. 1297-1306. Date of Electronic Publication: 2024 Jun 25.
DOI: 10.1016/j.hlc.2024.02.020
Abstrakt: Background: Patients with angina and non-obstructive coronary arteries (ANOCA) frequently have coronary vasomotor disorders (CVaD), characterised by transient pathological vasoconstriction and/or impaired microvascular vasodilatation. Functional coronary angiography is the gold standard for diagnosing CVaD. Despite recommendations, testing is only available at a limited number of Australian and New Zealand centres. This study aimed to determine the prevalence of CVaDs in an Australian ANOCA population and identify predictive factors associated with specific endotypes.
Method: Functional coronary angiography was performed in patients with suspected ANOCA. Vasoreactivity testing was performed using intracoronary acetylcholine provocation. A pressure-temperature sensor guidewire was used for coronary physiology assessment. Comprehensive clinical data on patient characteristics, cardiac risk factors, and symptom profiles was collected before testing.
Results: This prospective observational study at Royal Prince Alfred and Concord Repatriation General Hospital included 110 patients (58±13 years with 63.6% women), with 81.8% (90/110) having a CVaD. Regarding specific ANOCA endotypes, microvascular angina (MVA) occurred in 31.8% (35/110) of cases, vasospastic angina (VSA) in 25.5% (28/110) and a mixed presentation of MVA and VSA in 24.5% (27/110) of patients. Patients with CVaD were found to be older (59±11 vs 51±15, p=0.024), overweight (61.1% vs 15.0%, p<0.001) and had a worse quality of life (EuroQol 5 Dimensions-5 Levels; 0.61 vs 0.67, p=0.043). MVA was associated with being overweight (odds ratio [OR] 4.2 [95% confidence interval [CI] 1.9-9.3]; p=0.015) and ischaemia on stress testing (OR 2.4 [95% CI 1.1-4.3]; p=0.028), while VSA was associated with smoking (OR 9.1 [95% CI 2.21-39.3]; p=0.007).
Conclusions: Coronary vasomotor disorders are highly prevalent among ANOCA patients. This study highlights the importance of increasing national awareness and the use of functional coronary angiography to evaluate and manage this unique cohort.
Competing Interests: Disclosures M.K.C.N. has received research support from Abbott Vascular. A.S.C.Y. has received minor honoraria and research support from Abbott Vascular and Philips Healthcare. The remaining authors have nothing to disclose.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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