Severe Coronary Tortuosity or Myocardial Bridging in Patients With Chest Pain, Normal Coronary Arteries, and Reversible Myocardial Perfusion Defects
We reviewed patients with normal or near-normal coronary angiograms enrolled in the SPAM contrast stress echocardiographic diagnostic study in which 400 patients with chest pain syndrome of suspected cardiac origin with a clinical indication to coronary angiography were enrolled. Patients underwent...
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| Veröffentlicht in: | The American journal of cardiology 2011-10, Vol.108 (7), p.973-978 |
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| creator | Gaibazzi, Nicola, MD Rigo, Fausto, MD Reverberi, Claudio, MD |
| description | We reviewed patients with normal or near-normal coronary angiograms enrolled in the SPAM contrast stress echocardiographic diagnostic study in which 400 patients with chest pain syndrome of suspected cardiac origin with a clinical indication to coronary angiography were enrolled. Patients underwent dipyridamole contrast stress echocardiography (cSE) with sequential analysis of wall motion, myocardial perfusion, and Doppler coronary flow reserve before elective coronary angiography. Ninety-six patients with normal or near-normal epicardial coronary arteries were screened for the presence of 2 prespecified findings: severely tortuous coronary arteries and myocardial bridging. Patients were divided in 2 groups based on the presence (false-positive results, n = 37) or absence (true-negative results, n = 59) of reversible myocardial perfusion defects during cSE and compared for history and clinical and angiographic characteristics. Prevalence of severely tortuous coronary arteries (35% vs 5%, p |
| doi_str_mv | 10.1016/j.amjcard.2011.05.030 |
| format | Article |
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Patients underwent dipyridamole contrast stress echocardiography (cSE) with sequential analysis of wall motion, myocardial perfusion, and Doppler coronary flow reserve before elective coronary angiography. Ninety-six patients with normal or near-normal epicardial coronary arteries were screened for the presence of 2 prespecified findings: severely tortuous coronary arteries and myocardial bridging. Patients were divided in 2 groups based on the presence (false-positive results, n = 37) or absence (true-negative results, n = 59) of reversible myocardial perfusion defects during cSE and compared for history and clinical and angiographic characteristics. Prevalence of severely tortuous coronary arteries (35% vs 5%, p <0.001) or myocardial bridging (13% vs 2%, p <0.05) was 7 times higher in patients who demonstrated reversible perfusion defects at cSE compared to those without reversible perfusion defects. No significant differences were found between the 2 groups for the main demographic variables and risk factors. Patients in the false-positive group more frequently had a history of effort angina (p <0.001) and ST-segment depression at treadmill electrocardiography (p <0.001). In conclusion, we hypothesize that patients with a positive myocardial perfusion finding at cSE but without obstructive epicardial coronary artery disease have a decreased myocardial blood flow reserve, which may be caused by a spectrum of causes other than obstructive coronary artery disease, among which severely tortuous coronary arteries/myocardial bridging may play a significant role.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2011.05.030</identifier><identifier>PMID: 21784382</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Chest Pain - diagnosis ; Chest Pain - epidemiology ; Chest Pain - etiology ; Coronary Angiography ; Coronary Circulation - physiology ; Coronary heart disease ; Coronary Vessel Anomalies - complications ; Coronary Vessel Anomalies - diagnosis ; Coronary Vessel Anomalies - epidemiology ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Diagnosis, Differential ; Diagnostic Errors ; Echocardiography, Doppler, Color ; Echocardiography, Stress ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Humans ; Incidence ; Italy - epidemiology ; Male ; Medical sciences ; Middle Aged ; Patients ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Torsion Abnormality - complications ; Torsion Abnormality - diagnosis ; Torsion Abnormality - epidemiology</subject><ispartof>The American journal of cardiology, 2011-10, Vol.108 (7), p.973-978</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. Oct 1, 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-8e7697835ecbe1598926f077369aef50714eade1031483287ffa50c3edb9313e3</citedby><cites>FETCH-LOGICAL-c476t-8e7697835ecbe1598926f077369aef50714eade1031483287ffa50c3edb9313e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.amjcard.2011.05.030$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24616852$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21784382$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gaibazzi, Nicola, MD</creatorcontrib><creatorcontrib>Rigo, Fausto, MD</creatorcontrib><creatorcontrib>Reverberi, Claudio, MD</creatorcontrib><title>Severe Coronary Tortuosity or Myocardial Bridging in Patients With Chest Pain, Normal Coronary Arteries, and Reversible Myocardial Perfusion Defects</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>We reviewed patients with normal or near-normal coronary angiograms enrolled in the SPAM contrast stress echocardiographic diagnostic study in which 400 patients with chest pain syndrome of suspected cardiac origin with a clinical indication to coronary angiography were enrolled. Patients underwent dipyridamole contrast stress echocardiography (cSE) with sequential analysis of wall motion, myocardial perfusion, and Doppler coronary flow reserve before elective coronary angiography. Ninety-six patients with normal or near-normal epicardial coronary arteries were screened for the presence of 2 prespecified findings: severely tortuous coronary arteries and myocardial bridging. Patients were divided in 2 groups based on the presence (false-positive results, n = 37) or absence (true-negative results, n = 59) of reversible myocardial perfusion defects during cSE and compared for history and clinical and angiographic characteristics. Prevalence of severely tortuous coronary arteries (35% vs 5%, p <0.001) or myocardial bridging (13% vs 2%, p <0.05) was 7 times higher in patients who demonstrated reversible perfusion defects at cSE compared to those without reversible perfusion defects. No significant differences were found between the 2 groups for the main demographic variables and risk factors. Patients in the false-positive group more frequently had a history of effort angina (p <0.001) and ST-segment depression at treadmill electrocardiography (p <0.001). In conclusion, we hypothesize that patients with a positive myocardial perfusion finding at cSE but without obstructive epicardial coronary artery disease have a decreased myocardial blood flow reserve, which may be caused by a spectrum of causes other than obstructive coronary artery disease, among which severely tortuous coronary arteries/myocardial bridging may play a significant role.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Chest Pain - diagnosis</subject><subject>Chest Pain - epidemiology</subject><subject>Chest Pain - etiology</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation - physiology</subject><subject>Coronary heart disease</subject><subject>Coronary Vessel Anomalies - complications</subject><subject>Coronary Vessel Anomalies - diagnosis</subject><subject>Coronary Vessel Anomalies - epidemiology</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Errors</subject><subject>Echocardiography, Doppler, Color</subject><subject>Echocardiography, Stress</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>Incidence</subject><subject>Italy - epidemiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Torsion Abnormality - complications</subject><subject>Torsion Abnormality - diagnosis</subject><subject>Torsion Abnormality - epidemiology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks9u1DAQhyMEotvCI4AsJNRLEzxx4tgXUFn-SgUqWsTR8jqT1ktiFzuptO_BA-NolwX1wsmy9fmb8fycZU-AFkCBv1gXelgbHdqipAAFrQvK6L1sAaKROUhg97MFpbTMJVTyIDuMcZ22ADV_mB2U0IiKiXKR_brAWwxIlj54p8OGXPowTj7acUN8IJ82fq5hdU9eB9teWXdFrCPnerToxki-2_GaLK8xjunMuhPy2YchwXvdaRgxWIwnRLuWfJ2LRbvq8V_zOYZuitY78gY7NGN8lD3odB_x8W49yr69e3u5_JCffXn_cXl6lpuq4WMusOGyEaxGs0KopZAl72jTMC41djVtoELdIlAGlWClaLpO19QwbFeSAUN2lB1vvTfB_5zSI9Rgo8G-1w79FJWQlDezNZHP7pBrPwWXmktQVdLkgwTVW8gEH2PATt0EO6QpKKBqDk2t1S40NYemaK1SaOne0518Wg3Y7m_9SSkBz3eAjkb3XdDO2PiXqzhwUc_cqy2HaWi3FoOKJuVksLUhzVW13v63lZd3DKa3zqaiP3CDcf9oULFUVF3MP2z-YJCcEjhjvwFFw81F</recordid><startdate>20111001</startdate><enddate>20111001</enddate><creator>Gaibazzi, Nicola, MD</creator><creator>Rigo, Fausto, MD</creator><creator>Reverberi, Claudio, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20111001</creationdate><title>Severe Coronary Tortuosity or Myocardial Bridging in Patients With Chest Pain, Normal Coronary Arteries, and Reversible Myocardial Perfusion Defects</title><author>Gaibazzi, Nicola, MD ; Rigo, Fausto, MD ; Reverberi, Claudio, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-8e7697835ecbe1598926f077369aef50714eade1031483287ffa50c3edb9313e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Chest Pain - diagnosis</topic><topic>Chest Pain - epidemiology</topic><topic>Chest Pain - etiology</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation - physiology</topic><topic>Coronary heart disease</topic><topic>Coronary Vessel Anomalies - complications</topic><topic>Coronary Vessel Anomalies - diagnosis</topic><topic>Coronary Vessel Anomalies - epidemiology</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Diagnosis, Differential</topic><topic>Diagnostic Errors</topic><topic>Echocardiography, Doppler, Color</topic><topic>Echocardiography, Stress</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>Incidence</topic><topic>Italy - epidemiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Torsion Abnormality - complications</topic><topic>Torsion Abnormality - diagnosis</topic><topic>Torsion Abnormality - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gaibazzi, Nicola, MD</creatorcontrib><creatorcontrib>Rigo, Fausto, MD</creatorcontrib><creatorcontrib>Reverberi, Claudio, MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gaibazzi, Nicola, MD</au><au>Rigo, Fausto, MD</au><au>Reverberi, Claudio, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe Coronary Tortuosity or Myocardial Bridging in Patients With Chest Pain, Normal Coronary Arteries, and Reversible Myocardial Perfusion Defects</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2011-10-01</date><risdate>2011</risdate><volume>108</volume><issue>7</issue><spage>973</spage><epage>978</epage><pages>973-978</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>We reviewed patients with normal or near-normal coronary angiograms enrolled in the SPAM contrast stress echocardiographic diagnostic study in which 400 patients with chest pain syndrome of suspected cardiac origin with a clinical indication to coronary angiography were enrolled. Patients underwent dipyridamole contrast stress echocardiography (cSE) with sequential analysis of wall motion, myocardial perfusion, and Doppler coronary flow reserve before elective coronary angiography. Ninety-six patients with normal or near-normal epicardial coronary arteries were screened for the presence of 2 prespecified findings: severely tortuous coronary arteries and myocardial bridging. Patients were divided in 2 groups based on the presence (false-positive results, n = 37) or absence (true-negative results, n = 59) of reversible myocardial perfusion defects during cSE and compared for history and clinical and angiographic characteristics. Prevalence of severely tortuous coronary arteries (35% vs 5%, p <0.001) or myocardial bridging (13% vs 2%, p <0.05) was 7 times higher in patients who demonstrated reversible perfusion defects at cSE compared to those without reversible perfusion defects. No significant differences were found between the 2 groups for the main demographic variables and risk factors. Patients in the false-positive group more frequently had a history of effort angina (p <0.001) and ST-segment depression at treadmill electrocardiography (p <0.001). In conclusion, we hypothesize that patients with a positive myocardial perfusion finding at cSE but without obstructive epicardial coronary artery disease have a decreased myocardial blood flow reserve, which may be caused by a spectrum of causes other than obstructive coronary artery disease, among which severely tortuous coronary arteries/myocardial bridging may play a significant role.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21784382</pmid><doi>10.1016/j.amjcard.2011.05.030</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cardiology. Vascular system Cardiovascular Cardiovascular disease Chest Pain - diagnosis Chest Pain - epidemiology Chest Pain - etiology Coronary Angiography Coronary Circulation - physiology Coronary heart disease Coronary Vessel Anomalies - complications Coronary Vessel Anomalies - diagnosis Coronary Vessel Anomalies - epidemiology Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Diagnosis, Differential Diagnostic Errors Echocardiography, Doppler, Color Echocardiography, Stress Electrocardiography Female Follow-Up Studies Heart Humans Incidence Italy - epidemiology Male Medical sciences Middle Aged Patients Retrospective Studies Risk Factors Severity of Illness Index Torsion Abnormality - complications Torsion Abnormality - diagnosis Torsion Abnormality - epidemiology |
| title | Severe Coronary Tortuosity or Myocardial Bridging in Patients With Chest Pain, Normal Coronary Arteries, and Reversible Myocardial Perfusion Defects |
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