scholarly journals A Possible Etiopathogenic Role of Sickle Cell Anemia in Ischemia With Nonobstructive Coronary Arteries

2020 ◽  
pp. 263246362097758
Author(s):  
Kofi Tekyi Asamoah
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Sickle Cell ◽  
Coronary Arteries ◽  
Sickle Cell Anemia ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress ◽  
Microvascular Angina ◽  
Artery Disease

Chest pain is a common clinical symptom, especially in patients with sickle cell anemia. Owing to the vast differential diagnosis, investigation can be challenging. Typical chest pain (angina) is often attributed to obstructive coronary artery disease, with patients being referred for exercise stress tests for confirmation. Microvascular angina is emerging as a cause of significant morbidity worldwide, clinically identical to obstructive coronary artery disease. Clinical assessment and exercise stress testing often give the same results, making differentiation difficult. Coronary angiography however shows either normal coronary arteries or a nonobstructive lesion. An incomplete understanding of the etiopathogenesis of microvascular angina may result in missed diagnosis and suboptimal treatment in some cases. Coronary microvascular dysfunction plays a key role in this phenomenon, driven by chronic inflammation, thrombotic microangiopathy, and endothelial dysfunction. This article reports the case of a young man with chest pain, linking the highlights of the pathophysiology of microvascular disease in sickle cell anemia to microvascular angina.

scholarly journals Management of ischaemia with non-obstructive coronary arteries (INOCA)

BMJ ◽  
2021 ◽  
pp. e060602
Author(s):  
John F Beltrame ◽  
Rosanna Tavella ◽  
Dione Jones ◽  
Chris Zeitz
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Personalised Medicine ◽  
Future Research ◽  
Comprehensive Review ◽  
Artery Disease

Abstract Up to half of patients undergoing elective coronary angiography for the investigation of chest pain do not present with evidence of obstructive coronary artery disease. These patients are often discharged with a diagnosis of non-cardiac chest pain, yet many could have an ischaemic basis for their symptoms. This type of ischaemic chest pain in the absence of obstructive coronary artery disease is referred to as INOCA (ischaemia with non-obstructive coronary arteries). This comprehensive review of INOCA management looks at why these patients require treatment, who requires treatment based on diagnostic evaluation, what clinical treatment targets should be considered, how to treat patients using a personalised medicine approach, when to initiate treatment, and where future research is progressing.

scholarly journals Exercise Stress Test Utility in Patients with Chest Pain Presumed to be of Cardiac Origin

2013 ◽  
Vol 12 (3) ◽  
pp. 146-150
Author(s):  
Philippa Bennett ◽  
◽  
Philip Dyer ◽  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Stress Tests ◽  
Prognostic Information ◽  
Artery Disease

Introduction: NICE stated exercise stress tests (EST) should not be used to diagnose obstructive coronary artery disease in patients presenting with chest pain presumed to be of cardiac origin. Methods: A retrospective review of 209 patients with presumed cardiac chest pain was done. EST results, GRACE scores and need for invasive coronary angiogram (ICA) were analysed to predict the need for readmission, intervention and future events. Results: The sensitivity of the EST in identifying obstructive coronary artery disease was 70%. The EST, ICA and the GRACE 6-month mortality had a 77%, 70% and 81% negative predictive value (NPV) for readmission respectively. Conclusion: EST, GRACE scores and ICA are useful in providing prognostic information but are poor predictors of readmission. Follow up and education programmes are needed to reduce this burden.

Gender Differences in Non-Obstructive Coronary Artery Disease

2020 ◽  
Vol 26 ◽  
Author(s):  
Maria Bergami ◽  
Marialuisa Scarpone ◽  
Edina Cenko ◽  
Elisa Varotti ◽  
Peter Louis Amaduzzi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Gender Differences ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischemic Heart Disease ◽  
Coronary Arteries ◽  
Obstructive Coronary Artery Disease ◽  
Ischemic Heart ◽  
Current Evidence ◽  
Artery Disease

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

Screening of Fabry Disease in Patients with Chest Pain Without Obstructive Coronary Artery Disease

2021 ◽  
Author(s):  
Aitor Hernández-Hernández ◽  
Carles Diez-López ◽  
Olga Azevedo ◽  
Julian Palomino-Doza ◽  
Fernando Alfonso ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Fabry Disease ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

scholarly journals Incremental value of QT interval for the prediction of obstructive coronary artery disease in patients with chest pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dong-Hyuk Cho ◽  
Jimi Choi ◽  
Mi-Na Kim ◽  
Hee-Dong Kim ◽  
Soon Jun Hong ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Qt Interval ◽  
Obstructive Coronary Artery Disease ◽  
Model Performance ◽  
Clinical Score ◽  
Qtc Prolongation ◽  
Artery Disease ◽  
Improved Model

AbstractIdentification of obstructive coronary artery disease (OCAD) in patients with chest pain is a clinical challenge. The value of corrected QT interval (QTc) for the prediction of OCAD has yet to be established. We consecutively enrolled 1741 patients with suspected angina. The presence of obstructive OCAD was defined as ≥ 50% diameter stenosis by coronary angiography. The pre-test probability was evaluated by combining QTc prolongation with the CAD Consortium clinical score (CAD2) and the updated Diamond-Forrester (UDF) score. OCAD was detected in 661 patients (38.0%). QTc was longer in patients with OCAD compared with those without OCAD (444 ± 34 vs. 429 ± 28 ms, p < 0.001). QTc was increased by the severity of OCAD (P < 0.001). QTc prolongation was associated with OCAD (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.81–2.85). With QTc, the C-statistics increased significantly from 0.68 (95% CI 0.66–0.71) to 0.76 (95% CI 0.74–0.78) in the CAD2 and from 0.64 (95% CI 0.62–0.67) to 0.74 (95% CI 0.72–0.77) in the UDF score, respectively. QT prolongation predicted the presence of OCAD and the QTc improved model performance to predict OCAD compared with CAD2 or UDF scores in patients with suspected angina.

Abstract P322: Health Status of Stable Patients With Obstructive or Non-Obstructive Coronary Artery Disease Compared With Healthy Controls

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Rosanna Tavella ◽  
Natalie Cutri ◽  
John F Beltrame
Keyword(s):  
Quality Of Life ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Summary Score ◽  
Healthy Controls ◽  
Sf 36 ◽  
Artery Disease

BACKGROUND. Patients with chest pain and no evidence of obstructive coronary artery disease on angiography (NoCAD) are frequently considered not to have significant pathology and their symptoms trivialized. This study compared the health status of patients with NoCAD, obstructive coronary artery disease (CAD) and healthy subjects. METHOD. Patients undergoing angiography within the preceding 12 months for the investigation of chest pain were categorized as NoCAD or CAD on the basis of the angiographic findings and completed a health-related quality of life instrument, the Short Form-36 (SF-36). These were compared with a ‘healthy control’ group that were randomly selected from the electronic white pages and recruited if they had no self-reported history of cardiovascular disease. Cross sectional comparisons between the three groups were age adjusted and performed using liner regression. RESULTS. As shown in the table below, the healthy controls were significantly younger and therefore comparison of SF36 scores were age adjusted. All SF-36 sub-scales (except for bodily pain) and summary scores (see table ), were significantly lower in the CAD and NoCAD groups compared to the healthy controls. There were no differences in SF-36 scores between NoCAD and CAD. CONCLUSION. Compared with a healthy population, patients with stable CAD and NoCAD have significantly poorer quality of life asF-36. Future management strategies need to address the health outcomes in these patients. Healthy Controls (n = 3168) NoCAD (n = 320) CAD (n = 828) Age 52 ± 15 57 ± 12 * 62 ± 11 # SF-36: Physical Summary Score 49 ± 10 41 ± 11 * 41 ± 11 # SF-36: Mental Summary Score 51 ± 10 46 ± 11 * 46 ± 11 # * p <0.01 for healthy controls vs NoCAD, # p <0.01 for healthy controls vs CAD

Abstract 13804: Clinical Profile and Outcomes of Myocardial Infarction With Non-obstructive Coronary Arteries in Older Adults

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ara H Rostomian ◽  
Derek Q Phan ◽  
Mingsum Lee ◽  
Ray X Zadegan
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Los Angeles ◽  
Coronary Arteries ◽  
Medical Center ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Kaiser Permanente ◽  
Artery Disease

Introduction: Myocardial Infarction with non-obstructive coronary artery disease (MINOCA) is found in 5%-6% of patients with acute myocardial infarction (AMI). As such, the diagnosis and management of AMI patients with non-obstructive coronary artery disease (NOCAD) poses a challenge as compared to patients with MI with coronary artery disease (MICAD). Hypothesis: To evaluate the characteristics and outcomes of MINOCA in older patients as compared with MICAD patients, with and without revascularization. Methods: This was a retrospective observational study of patients ≥80 years old who underwent invasive coronary angiography (ICA) for AMI between 2009-2019 at Kaiser Permanente Los Angeles Medical Center. MINOCA was defied as <50% stenosis of coronary arteries on angiography with a troponin level ≥0.05 ng/ml. Patients with MINOCA vs MICAD were compared. Multivariate logistic regression was used to identify independent predictors of MINOCA and Kaplan-Meier survival analysis was used to analyze all-cause mortality between cohorts. Results: A total of 259 patients with MINOCA (mean ± SD age 83.8±2.7 years, 68% female) and 687 patients with MICAD (84.7±3.4 years, 40% female) were analyzed. Younger age (odds ratio [OR]=1.11; 95% confidence interval [CI]=1.05-1.18), female sex (OR=3.14; CI=2.20-4.48), black race (OR=2.53; CI=1.61-3.98), no history of prior stroke (OR=1.56; CI=1.06-2.33), atrial fibrillation or flutter (OR=2.04; CI:1.38-3.02), lower troponin levels (OR=1.08; CI:1.03-1.11), and lower triglyceride levels per 10 mg/dl increments (OR=1.06; CI:1.03-1.11) increased the odds of having MINCOA as compared to MICAD. At median follow-up of 2.4 years, MINOCA was associated with a lower rate of death (44.8% vs 55.2%, p<0.01) compared to un-revascularized MICAD, but no difference (31.3% vs 40.4%, p=0.68) when compared to re-vascularized MICAD. Conclusions: Patients age ≥80 years with MINOCA have fewer traditional risk factors compared to their counterparts with MICAD and fewer deaths compared to un-revascularized MICAD, but similar mortality compared to revascularized MICAD

Abstract 129: Chest Pain Characteristics of Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA) in Comparison to Myocardial Infarction With Coronary Artery Disease (MI-CAD)

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Sivabaskari Pasupathy ◽  
Rosanna Tavella ◽  
Margaret Arstall ◽  
Derek Chew ◽  
Matthew Worthley ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Public Hospitals ◽  
Arm Pain ◽  
Retrosternal Pain ◽  
Pain Characteristics ◽  
Artery Disease

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is being increasingly recognized with the frequent use of angiography following Acute Myocardial Infarction (AMI); yet there is little evaluation of these patients in the literature. The current study is a prospective, contemporary analysis of clinical features and chest pain characteristics between patients with MINOCA and Myocardial Infarction with coronary artery disease (MI-CAD). Methods: All consecutive patients undergoing coronary angiography for AMI (as per the Third Universal AMI Definition) in South Australian public hospitals from January 2012 - December 2013 were included. Data was captured by Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR ® CathPCI ® Registry. The AMI patients were classified as MI-CAD or MINOCA on the basis of the presence or absence of a significant stenosis (≥50%) on angiography. Results: From 3,431 angiography procedures undertaken for AMI, 359 (11%) were classified as MINOCA. MINOCA patients were younger (59 ± 15 vs. 64 ± 13, p <0.01) and more likely to be female (60% vs. 26%, p<0.01), with age adjusted analysis revealing less cardiovascular risk factors in MINOCA compared to MICAD: current smoker (21% vs. 35%, p< 0.01), hypertension (56% vs. 65%, p<0.01), dyslipidaemia (46% vs. 61%, p<0.01), and diabetes (20% vs. 32%, p<0.01). Analysis of presenting chest pain characteristics showed no significant differences between MICAD and MINOCA for the presence of retrosternal pain (81% vs. 82%, p>0.05,) or shoulder pain (27% vs. 26%, p>0.05) respectively, however MINOCA patients were less likely to experience arm pain (33% vs. 40%, p<0.01). In regards to precipitating factors, emotional stress was more common (14% vs. 5%, p<0.001) and exertion related chest pain was less common (27% vs. 40%, p<0.001) in MINOCA patients. Quality of pain for MINOCA and MICAD was similar with the most frequent descriptors being burning (11% vs. 9%, p>0.05), sharp 21% vs. 23%, p>0.05) and tightness (41% vs. 44%, p>0.05). In addition, there were no significant differences observed between groups in relieving factors and duration of chest pain Conclusions: In contemporary cardiology practice, MINOCA presentation is more common than previously appreciated, with younger women frequently implicated. Delineating a MINOCA patient from MICAD on the basis of chest pain characteristics is not feasible.

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