Echocardiography (Mount Kisco, N.Y.) · 2025
The Role of Stress Echocardiography in Patients With Anomalous Aortic Origin of Coronary Arteries: Two Tertiary Cardiac Centers' Experience.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Danylenko Oleksandr, Lwin Myo Thidar, Kasouridis Ioannis, Masding Abigail, Klemperer Katherine Von, Macrae Rebecca, Monteiro Ricardo Prista, Senior Roxy, Li Wei
Аннотация
AIMS: The objective of our study was to establish the prevalence of ischemia during exercise stress echocardiography (ESE) in patients with anomalous aortic origin of coronary arteries (AAOCA).
METHODS AND RESULTS: A cohort of 46 patients with AAOCA was retrospectively included in this study. Treadmill/bike exercise stress echo tests for ischemia assessment were performed and analyzed according to ESC guidelines. Computed tomography coronary angiography (CTCA), cardiac magnetic resonance, myocardial perfusion scintigraphy and invasive angiography with intravascular ultrasound if needed were used for coronary artery (CA) morphology and myocardial perfusion assessment. Most patients (70%) were overall symptomatic at rest, 57% reported chest pain and 2% had cardiac arrest before the ESE. By contrast, only 2% of patients reported chest pain during ESE. CTCA revealed that 70% of patients had an inter-arterial course, 17% were found to have an intramural course and 24% had a slit-like ostium of their anomalous CA. Other high-risk features were less frequent findings. All myocardial perfusion studies were negative and only one patient with AAOCA developed ischemia during ESE. Following investigations, four patients were eligible for surgical interventions and were operated on while the remaining patients were followed up for a median of 3 years with no adverse cardiovascular events.
CONCLUSIONS: Incidence of ischemia on exercise stress echo is extremely low among middle-aged patients with AAOCA despite symptoms at rest and malignant anatomical features. A good short-term outcome in unoperated AAOCA patients following negative exercise stress echocardiography has been shown.
METHODS AND RESULTS: A cohort of 46 patients with AAOCA was retrospectively included in this study. Treadmill/bike exercise stress echo tests for ischemia assessment were performed and analyzed according to ESC guidelines. Computed tomography coronary angiography (CTCA), cardiac magnetic resonance, myocardial perfusion scintigraphy and invasive angiography with intravascular ultrasound if needed were used for coronary artery (CA) morphology and myocardial perfusion assessment. Most patients (70%) were overall symptomatic at rest, 57% reported chest pain and 2% had cardiac arrest before the ESE. By contrast, only 2% of patients reported chest pain during ESE. CTCA revealed that 70% of patients had an inter-arterial course, 17% were found to have an intramural course and 24% had a slit-like ostium of their anomalous CA. Other high-risk features were less frequent findings. All myocardial perfusion studies were negative and only one patient with AAOCA developed ischemia during ESE. Following investigations, four patients were eligible for surgical interventions and were operated on while the remaining patients were followed up for a median of 3 years with no adverse cardiovascular events.
CONCLUSIONS: Incidence of ischemia on exercise stress echo is extremely low among middle-aged patients with AAOCA despite symptoms at rest and malignant anatomical features. A good short-term outcome in unoperated AAOCA patients following negative exercise stress echocardiography has been shown.