Is Exercise Stress Testing Useful for Risk Stratification in Anomalous Aortic Origin of a Coronary Artery?

Qasim, Amna; Doan, Tam; Pham, Tam Dan N.; Reaves-O’Neal, Dana; Sachdeva, Shagun; Mery, Carlos M.; Binsalamah, Ziyad M.; Molossi, Silvana

doi:10.1053/j.semtcvs.2022.08.009

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…In another study with longitudinal data, Brothers et al reported a low incidence of ischaemia detection in a small number of symptomatic patients with ACAOS who underwent a preoperative physical stress test ( 30 ), which was consistent with our findings. It is well known that these tests may yield false negative results in patients with ACAOS because of the difficulty in reproducing intermittent ischaemia ( 31 ). To attempt to overcome this problem in postoperative evaluation, patients underwent the EST, which included reaching a high physical workload beyond the classical exercise target of 85% of the maximum heartbeat based on the patient's age, as previously suggested ( 28 ), although reliable predictive targets have not been validated in this context in any study.…”

Section: Discussionmentioning

confidence: 99%

“…To attempt to overcome this problem in postoperative evaluation, patients underwent the EST, which included reaching a high physical workload beyond the classical exercise target of 85% of the maximum heartbeat based on the patient's age, as previously suggested ( 28 ), although reliable predictive targets have not been validated in this context in any study. Recent data have suggested that cardiopulmonary exercise test has an increased sensitivity for the detection of myocardial ischaemia ( 31 ). Finally, stress MRI has become an increasingly interesting and suitable modality for the detection of myocardial ischaemia in both children and adult patients with ACAOS ( 32 , 33 ).…”

Section: Discussionmentioning

confidence: 99%

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Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus

André

Hodžić

Dolladille

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesWe sought to assess the resumption of sport, exercise performances, and quality of life (QoL) in adults and children after surgical repair of anomalous coronary arteries originating from the opposite sinus (ACAOS).Materials and methodsPatients who underwent surgical repair for ACAOS between 2002 and 2022 were retrospectively identified. Information about sports activity and exercise performance based on metabolic equivalents of task (METs) calculated at the last exercise stress test, were collected. QoL was assessed using age-appropriate questionnaires (Paediatric QoL Inventory, cardiac module version 3.0 for patients <18 years; SF-36 QoL Inventory for adults). Patients' METS and patients’ QoL-scores were compared to reference population using the Wilcoxon test.Results45 patients were enrolled (males 71%, adults 49%, anomalous right coronary 84%). Median age at surgery was 15 years; median follow-up after surgery was 2.3 years [4 months–12 years]. All post-operative exercise stress tests were normal, METs and VO2 max patients' values did not differ from healthy children or adults (Exercise intensity: 12.5 ± 4.7 vs. 13.4 ± 2 METS, p = 0.3; VO2 max: 43.6 ± 16.6 vs. 46.9 ± 7 ml/kg/min, p = 0.37). For adults, QoL—scores were similar between ACAOS patients and controls. For children, there was no significant difference between the study patients' scores and those of the reference population, except for physical appearance proxy-report (p = 0.02).ConclusionIn our study, the practice of sports, exercise stress testing and QoL were not adversely affected after ACAOS repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus

André

Hodžić

Dolladille

et al. 2023

Front. Cardiovasc. Med.

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“…16 In addition to monitoring cardiac rhythm and blood pressure, metabolic data during exercise was collected via expiratory gases and volumes samples using breath-by-breath analysis software on metabolic cart. 17 The test would be terminated if there was chest pain, syncope, ST change concerning for ischemia, higher grade arrhythmias, or patient request.…”

Section: Methodsmentioning

confidence: 99%

Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Large Pediatric Cohort Medium-Term Outcomes

Doan

Sachdeva

Bonilla-Ramirez

et al. 2023

Circ: Cardiovascular Interventions

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Background: Anomalous aortic origin of a right coronary artery may cause myocardial ischemia and sudden death in the young. Data on myocardial ischemia or longitudinal outcomes are sparse in pediatric anomalous aortic origin of a right coronary artery population. Methods: Patients <21 years with anomalous aortic origin of a right coronary artery were prospectively enrolled. Computerized tomography angiography defined morphology. Exercise stress test and stress perfusion imaging (sPI) were performed if >7 years or younger with concern for ischemia. High-risk features included intramural length, slit-like/hypoplastic ostium, exertional symptoms, or evidence of ischemia. Results: A total of 220 patients (60% males) were enrolled December 2012 to April 2020 at a median age 11.4 years (interquartile range, 6.1–14.5), including 168 (76%) with no/nonexertional symptoms (group 1) and 52 (24%) with exertional chest pain/syncope (group 2). Computerized tomography angiography was available in 189/220 (86%), exercise stress test in 164/220 (75%), and sPI in 169/220 (77%). Exercise stress test was positive in 2/164 (1.2%) patients in group 1, both had positive sPI. Inducible ischemia (sPI) was detected in 11/120 (9%) in group 1 and 9/49 (18%) in group 2 ( P =0.09). Intramural length was similar in patients with/without ischemia (5 [interquartile range, 4–7] versus 5 [interquartile range, 4–7] mm; P =0.65). Surgery was recommended in 56/220 (26%) patients with high-risk features. In 52 surgical patients (38 unroofing, 14 reimplantation), all subjects were alive and have returned to exercise at last median follow-up of 4.6 (interquartile range, 2.3–6.5) years. Conclusions: Anomalous aortic origin of a right coronary artery patients can present with inducible ischemia on sPI despite symptoms or intramural length. Exercise stress test is a poor predictor of ischemia and caution should be given to determine low-risk based solely on this assessment. All patients are alive at medium-term follow-up.

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“…Today, thanks to the technological improvements and more user‐friendly software to analyze functional data, it is starting to be widely used in cardiology, both for adults and children. It has the advantage of a contemporary assessment of stress ECG and respiratory gas analysis, without radiation exposure, providing indexes of cardiac and systolic output (i.e., peak oxygen uptake and oxygen pulse, respectively) 59–62 . Importantly, it allows reaching the same HR usually reached during physical exercise and in a more physiological way.…”

Section: Diagnosismentioning

confidence: 99%

“…In particular, CPET not only provides peak oxygen uptake and peak oxygen pulse values, but the trajectory of these parameters seems to reflect the trend of cardiac and systolic output during the incremental exercise, respectively. When a cycloergometer is used for the CPET, also the oxygen uptake to work rate ratio can be useful in suspecting an inducible myocardial ischemia 59–62 …”

Section: Diagnosismentioning

confidence: 99%

Congenital coronary artery anomalies in sports medicine. Why to know them

Zeppilli

Bianco

Gervasi

et al. 2023

Clinical Cardiology

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The anomalous origin of a coronary artery (AOCA) is a challenging topic, due to its rarity, the complexity of the pathophysiological aspects, the clinical presentation (often silent), the difficulty of diagnosis, and the potential risk of causing acute cardiovascular events up to sudden cardiac death, particularly when triggered by heavy physical exercise or sport practice. Increasing interest in sport medical literature is being given to this topic. This paper reviews current knowledge of AOCAs in the specific context of the athletic setting addressing epidemiological and pathophysiological aspects, diagnostic work‐up, sports participation, individual risk assessment, therapeutic options, and return to play decision after surgery.

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Is Exercise Stress Testing Useful for Risk Stratification in Anomalous Aortic Origin of a Coronary Artery?

Cited by 10 publications

References 30 publications

Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus

Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus

Ischemia in Anomalous Aortic Origin of a Right Coronary Artery: Large Pediatric Cohort Medium-Term Outcomes

Congenital coronary artery anomalies in sports medicine. Why to know them

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