Severe Coronary Tortuosity or Myocardial Bridging in Patients With Chest Pain, Normal Coronary Arteries, and Reversible Myocardial Perfusion Defects

Gaibazzi, Nicola; Rigo, Fausto; Reverberi, Claudio

doi:10.1016/j.amjcard.2011.05.030

Cited by 66 publications

(67 citation statements)

References 16 publications

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“…[30][31][32] Coronary tortuosity is a challenging problem during coronary angioplasty, and it is related to several complications, such as vessel dissection, stent loss, and even acute arterial occlusion. 33 Its presence is also related to a larger quantity of radiation during the procedure, 34 and a difficulty to use adjunct methods in coronary angioplasty, such as intracoronary ultrasound, optical coherence tomography, and fractional flow reserve measurement. It is a predictor of failure in thrombus aspiration during primary angioplasty and recanalization of chronic occlusions.…”

Section: Coronary Tortuosity and Coronary Angioplastymentioning

confidence: 99%

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Estrada

Lopes

Villacorta

2017

International Journal of Cardiovascular Sciences

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The objective of this study is to make a review of the narrative of coronary artery tortuosity (CAT) approaching several situations in clinical practice where tortuosity can have a relevant role, and also evaluate if tortuosity can be related to the presence of myocardial ischemia in patients without coronary obstruction using scientific evidences in medical literature. Textbook of applied Physiology in Cardiology with study of coronary circulation, theoretical articles with studies of Hemodynamics, Fluid and Mechanical Dynamic, and experimental articles with simulation in computers were used as support to answer this last question. Introduction Coronary circulationThere are two basic types of coronary vessels: conductance and resistance vessels. The epicardial arteries, right and left, and its main and major branches that emerge in acute angle of relative large caliber work as vessels of conductance offering in the diastole minimum resistance to the blood flow. The deep perforators that originate in a right angle of the epicardial arteries penetrate deeply in the myocardial walls and nurture sub endocardial layers offering great resistance to the flow mainly in the ventricular systole. They are responsible for the coronary flow autoregulation maintaining it adequately in broad spectrum of the pressure variation and increasing the flow in exercising situations mainly through the local metabolic regulation. Microcirculation is part of the coronary circulation constituted by arterioles and capillaries responsible for regulating the oxygen supply to the myocardium.The heart is a highly aerobic organ, but it depends almost exclusively on the oxidation of the substrates to generate energy which will move it and has almost no oxygen reserve. It receives about 5% of cardiac output and it is a little perfused organ, but it is the organ that has the highest oxygen extraction of the organism.Taking into consideration Fick's equation (oxygen consumption = coronary flow X arteriovenous difference of oxygen), we verified that the physiological determinants of the coronary flow are the same that command the demand and consumption of oxygen: blood pressure, heart rate, ventricular wall tension, dP/dt maximum.According to Poiseuille's law, the flow in any vessel system is directly proportional to the difference of pressure in its extremities, and inversely proportional to the resistance of the system, which is in turn proportional to the length of the tube, viscosity of the fluid and inversely proportional to the fourth power of the radius (most important factor). Influences of vasomotility of the autonomous nervous system, of drugs, mainly of local autoregulation, determine variations in the flow. Due to cyclical pressure and variations and myocardium tension, the coronary flow, in the systole represents from 25% to 30% of the total, and from 70% to 75% in the diastole.Factors that can affect myocardial consumption of oxygen and consequently the coronary flow can be divided into 3 groups: a) Factors that affect consump...

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Section: Coronary Tortuosity and Coronary Angioplastymentioning

confidence: 99%

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Estrada

Lopes

Villacorta

2017

International Journal of Cardiovascular Sciences

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“…Stress SPECT can detect reversible myocardial perfusion defects in patients with myocardial bridging and relate the amount of ischemia to the degree of systolic luminal narrowing (34,35). Contrast stress echocardiography has been reported for myocardial bridge detection but is less validated (36). …”

Section: Diagnosismentioning

confidence: 99%

Myocardial Bridging

Corban

Hung

Eshtehardi

et al. 2014

Journal of the American College of Cardiology

229

128

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“…1–4 The presence of TCA has been associated with chest pain and myocardial perfusion abnormalities during stress in the absence of obstructive coronary artery disease. 2,5,6 Fluid dynamic modeling suggests that stress-induced ischemia may be attributable to a reduction in distal coronary artery perfusion pressure from viscous and turbulence energy losses. 7,8 The physiologic reasons for TCA are unclear.…”

mentioning

confidence: 99%

Increased Coronary Tortuosity Is Associated with Increased Left Ventricular Longitudinal Myocardial Shortening

Oehler

Minnier

Lindner

2017

Journal of the American Society of Echocardiography

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Background The mechanistic basis for tortuosity of the coronary arteries (TCA) is unclear. We hypothesized that the relative degree of systolic longitudinal shortening of the LV which deforms co-axially-oriented coronary arteries is associated with TCA. Methods Adult subjects undergoing coronary angiography and comprehensive echocardiography within 3 months were classified dichotomously as with (n=32) or without (n=42) TCA defined based on number and severity of coronary angles. Systolic LV longitudinal deformation was determined by mitral annular plane systolic excursion (MAPSE) from both B-mode displacement and tissue Doppler time-velocity integral; data were indexed to LV diastolic long-axis length. Results There were no differences between groups with respect to age, gender, hypertension, or coronary artery disease. Patients with TCA had significantly (p<0.01) lower LV mass index and a shorter total LV diastolic long-axis length (8.3±1.9 vs 9.1±2.2 cm, p<0.01). Despite having a shorter length, those with TCA had a greater MAPSE by both methods. MAPSE normalized to diastolic length was significantly greater (p<0.01) in those with TCA, and remained the case after excluding subjects with reduced LV ejection fraction. Multiple linear regression found that lateral annular MAPSE had the largest effect size with a 13-fold increase in likelihood for TCA for every 0.1 of normalized MAPSE. Conclusions TCA is not associated with increased LV mass but rather with smaller hearts that have greater relative longitudinal shortening of the LV. This finding suggests that TCA could represent an adaptive response to longitudinal systolic distortion of co-axially-oriented coronary arteries that dynamically produce shear stresses associated with expansive coronary remodeling.

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Severe Coronary Tortuosity or Myocardial Bridging in Patients With Chest Pain, Normal Coronary Arteries, and Reversible Myocardial Perfusion Defects

Cited by 66 publications

References 16 publications

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

Myocardial Bridging

Increased Coronary Tortuosity Is Associated with Increased Left Ventricular Longitudinal Myocardial Shortening

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