Coronary artery spasm and impaired myocardial perfusion in patients with ANOCA: Predictors from a multimodality study using stress CMR and acetylcholine testing
| Autor: | Heiko Mahrholdt, Astrid Hubert, Peter Ong, Valeria Martínez Pereyra, Udo Sechtem, Giancarlo Pirozzolo, Andreas Seitz, Raffi Bekeredjian, Fabian Guenther |
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| Rok vydání: | 2021 |
| Předmět: |
Spasm
medicine.medical_specialty Vasodilator Agents Coronary Angiography Angina Coronary circulation Percutaneous Coronary Intervention Coronary Circulation Internal medicine otorhinolaryngologic diseases medicine Humans cardiovascular diseases Myocardial infarction Ejection fraction business.industry medicine.disease Coronary Vessels Acetylcholine nervous system diseases Perfusion body regions Coronary arteries stomatognathic diseases medicine.anatomical_structure Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | International Journal of Cardiology. 343:5-11 |
| ISSN: | 0167-5273 |
| Popis: | Background Functional coronary disorders such as coronary spasm and microvascular dysfunction (including microvascular spasm and impaired microvascular dilatation) are frequent findings among patients with angina and non-obstructed coronary arteries (ANOCA). In this study, we investigated a potential association of coronary spasm and myocardial perfusion abnormalities as well as predictors of such functional coronary disorders in ANOCA patients using a multimodality diagnostic strategy including adenosine stress CMR and intracoronary acetylcholine testing. Methods We enrolled 129 patients with ANOCA who underwent acetylcholine testing and adenosine stress perfusion CMR. Patients were allocated to 3 groups according to their spasm testing result with regard to standardized COVADIS criteria: 1) epicardial spasm, 2) microvascular spasm, and 3) no spasm. The myocardial perfusion reserve index (MPRI) was semiquantitatively determined from adenosine stress perfusion CMR. Multivariate regression analyses were performed to identify predictors of coronary functional disorders. Results Patients with epicardial spasm had lower MPRI than patients without, whereas MPRI was preserved in patients with microvascular spasm. Multivariate analyses revealed age, previous myocardial infarction, LVEF and epicardial spasm as independent predictors of diminished MPRI, whereas previous PCI was associated with epicardial spasm, and female sex was a strong predictor of microvascular spasm. Conclusions Our results demonstrate coexistence of different functional coronary disorder endotypes involving the macro- and microvascular level of the coronary circulation in patients with ANOCA. We demonstrate that epicardial spasm is associated with diminished myocardial perfusion reserve and report further predictors of coronary functional disorders. |
| Databáze: | OpenAIRE |
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