The Experts below are selected from a list of 30 Experts worldwide ranked by ideXlab platform
Udo Sechtem - One of the best experts on this subject based on the ideXlab platform.
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P875Myocardial perfusion reserve assessment in patients with angina pectoris and suspected coronary spasm
European Heart Journal, 2019Co-Authors: G Pirozzolo, Heiko Mahrholdt, A Seitz, A Becker, T Schaeufele, R Bekeredjian, Udo SechtemAbstract:Abstract Background Patients with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries represent a diagnostic and therapeutic challenge. Coronary Vasomotor Disorders such as coronary epicardial or microvascular spasm are frequently found among these patients. They can be diagnosed using intracoronary acetylcholine testing (ACH-test). It has been shown that patients with epicardial spasm have a worse prognosis compared to patients with microvascular spasm. The reasons for this finding are however not apparent. We speculated in this study that patients with epicardial spasm have a worse Vasomotor dysfunction compared to patients with microvascular spasm or normal ACH-test. To assess this hypothesis all patients in this study not only underwent ACH-testing but in addition also adenosine stress perfusion cardiac MRI (CMR) with calculation of the myocardial perfusion reserve index (MPRI). The latter method allows for assessment of vasodilatory function compared to the vasoconstrictor assessment using acetylcholine. Methods Between 2012 and 2016, 129 consecutive patients (mean age 64±13 years, 46% female) with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries were enrolled in this study. All patients underwent ACH-testing as well as adenosine stress perfusion CMR. According to the results of the acetylcholine test, patients were allocated to 3 groups: a) epicardial spasm (angina, ischemic ECG changes and >75% coronary diameter reduction), b) microvascular spasm (angina, ischemic ECG changes and <75% coronary diameter reduction) and c) no evidence of coronary artery spasm. CMR-derived MPRI was calculated semiquantitatively from myocardial signal intensity-over-time curves of adenosine stress and rest perfusion. Results Epicardial and microvascular spasm was found in 31 (24%) and 69 (53%) patients, respectively, while 29 (22%) patients had no evidence of coronary spasm on ACH-testing. Women were more likely to have microvascular spasm than men (68% vs. 36%, p<0.001). The prevalence of epicardial spasm did not significantly differ between female and male patients (18% vs. 31%, p=0.08). MPRI was similar in patients with microvascular spasm compared to patients without spasm (1.30 vs. 1.27, p=0.43). However, patients with epicardial spasm had significantly lower MPRI than patients without spasm (1.16 vs. 1.30, p<0.05) or those with microvascular spasm (1.16 vs. 1.27, p<0.05). Conclusion MPRI determined by stress perfusion CMR was significantly reduced in patients with epicardial spasm compared to those with microvascular spasm or normal ACH-test. This could indicate that patients with epicardial spasm have a more generalized coronary Vasomotor Disorder compared to other patients. This may be the reason for the worse outcome observed and could lead to more aggressive medical therapy and closer follow-up. Acknowledgement/Funding This work was funded by the Robert-Bosch-Stiftung, Stuttgart, Germany and the Berthold-Leibinger-Stiftung, Ditzingen, Germany.
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P6004Safety assessment and results of coronary spasm provocation testing in patients with MINOCA compared to patients with stable angina and unobstructed coronary arteries
European Heart Journal, 2019Co-Authors: S Probst, A Seitz, G Pirozzolo, A Becker, T Schaeufele, R Bekeredjian, Udo SechtemAbstract:Abstract Background Approximately 10% of patients with acute myocardial infarction do not have a culprit lesion. Such patients have been labelled as MINOCA (myocardial infarction with non-obstructive coronary arteries) and several pathophysiological etiologies have been described as potential explanations. This includes spontaneous coronary dissection, tako-tsubo-syndrome and coronary spasm. The latter can be diagnosed during invasive provocative testing. The aim of this study was to assess the frequency of coronary spasm and the safety of intracoronary provocation testing using acetylcholine in MINOCA patients compared to patients with stable angina and unobstructed coronary arteries. Methods Between 2007 and 2018 180 consecutive patients with either MINOCA or stable angina and unobstructed coronary arteries were enrolled. MINOCA was defined as acute onset of chest pain with either ST-segment elevation on the ECG or significant high sensitive troponin T elevation but no relevant epicardial stenosis (<50%) according to the current ESC guidelines. All patients underwent intracoronary acetylcholine provocation testing (ACH-test) in search of coronary spasm according to a standardized protocol immediately after diagnostic coronary angiography. Apart from systematic assessment of clinical, demographic and risk factor data, data regarding complications during the ACH-test were meticulously recorded. Results Eighty patients with MINOCA and 100 consecutive patients with stable angina were recruited (52% women, mean age 62±13 years). Overall, 59% had hypertension and 20% had diabetes. Comparison of clinical, demographic and risk factor data did not reveal any statistically significant differences except for a female preponderance in the stable patients (61% vs. 40%, p=0.007). The ACH-test revealed a coronary Vasomotor Disorder in 68% of cases. In 32% of cases the ACH-test was either inconclusive or negative. Epicardial spasm was found in 31% of patients with a higher prevalence among the MINOCA patients compared to the stable angina patients (41% vs. 23%, p=0.002). Microvascular spasm was found in 37% with a higher prevalence among the stable angina patients compared to the MINOCA cohort (49% vs. 23%, p=0.002). Assessment of complications during the ACH-test revealed that 13 MINOCA patients and 15 stable angina patients had minor complications such as intermittent atrioventricular block, sinusbradycardia, paroxysmal atrial fibrillation, ventricular ectopic beats or transient hypotension. Comparison of minor complications between the two groups did not reveal statistically significant differences (16% vs. 15%, p=0.839). None of the patients experienced any irreversible complications. Conclusion Coronary spasm is a frequent cause for MINOCA. Intracoronary spasm provocation testing using acetylcholine is feasible in such patients. The complication rate during ACH-testing in MINOCA patients is low and comparable to patients with stable angina. Acknowledgement/Funding Berthold-Leibinger-Foundation, Ditzingen, Germany
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Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)
Clinical Research in Cardiology, 2012Co-Authors: Anastasios Athanasiadis, Heiko Mahrholdt, Gabor Borgulya, Udo Sechtem, Juan Carlos KaskiAbstract:Aims Cardiac syndrome X (CSX) is characterized by exercise-induced angina, positive exercise stress-test responses and angiographically normal coronary arteries. The condition characteristically affects more women than men and is often associated with coronary microvascular dysfunction, i.e., abnormal vasodilatory responses. Recent clinical observations suggest that increased coronary vasoconstriction may have a pathogenic role in CSX. We therefore sought to assess the prevalence of increased epicardial and microvascular coronary vasoconstriction in women with CSX. Methods and results Among 1,120 consecutive women with angina undergoing diagnostic coronary angiography 39 fulfilled criteria for CSX (mean age 63 ± 9 years) and were included in the study (27 also complained about rest angina). Five women without angina (mean age 64 ± 24 years) and normal coronary arteriograms served as controls. Patients and controls underwent intracoronary acetylcholine testing with a standardized protocol. Severe (≥75 % diameter reduction) epicardial constriction developed in 12 CSX patients (31 %) with reproduction of their angina in 10. All 12 patients showed diffuse epicardial constriction affecting mainly the distal coronary segments. Twenty-two CSX patients (56 %) experienced their usual angina without epicardial constriction of which 21 had ischemic ECG shifts. The remaining five CSX patients (13 %) had no angina or constriction in response to acetylcholine. None of the control patients had angina or constriction during ACH testing. Conclusion Increased epicardial as well as microvascular coronary constriction in response to acetylcholine are frequent findings in women with CSX. The results indicate that inappropriate coronary constriction is likely to contribute to the anginal symptoms of these patients. The ACH-test may be useful in the clinical setting to unmask this Vasomotor Disorder.
Heiko Mahrholdt - One of the best experts on this subject based on the ideXlab platform.
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P875Myocardial perfusion reserve assessment in patients with angina pectoris and suspected coronary spasm
European Heart Journal, 2019Co-Authors: G Pirozzolo, Heiko Mahrholdt, A Seitz, A Becker, T Schaeufele, R Bekeredjian, Udo SechtemAbstract:Abstract Background Patients with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries represent a diagnostic and therapeutic challenge. Coronary Vasomotor Disorders such as coronary epicardial or microvascular spasm are frequently found among these patients. They can be diagnosed using intracoronary acetylcholine testing (ACH-test). It has been shown that patients with epicardial spasm have a worse prognosis compared to patients with microvascular spasm. The reasons for this finding are however not apparent. We speculated in this study that patients with epicardial spasm have a worse Vasomotor dysfunction compared to patients with microvascular spasm or normal ACH-test. To assess this hypothesis all patients in this study not only underwent ACH-testing but in addition also adenosine stress perfusion cardiac MRI (CMR) with calculation of the myocardial perfusion reserve index (MPRI). The latter method allows for assessment of vasodilatory function compared to the vasoconstrictor assessment using acetylcholine. Methods Between 2012 and 2016, 129 consecutive patients (mean age 64±13 years, 46% female) with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries were enrolled in this study. All patients underwent ACH-testing as well as adenosine stress perfusion CMR. According to the results of the acetylcholine test, patients were allocated to 3 groups: a) epicardial spasm (angina, ischemic ECG changes and >75% coronary diameter reduction), b) microvascular spasm (angina, ischemic ECG changes and <75% coronary diameter reduction) and c) no evidence of coronary artery spasm. CMR-derived MPRI was calculated semiquantitatively from myocardial signal intensity-over-time curves of adenosine stress and rest perfusion. Results Epicardial and microvascular spasm was found in 31 (24%) and 69 (53%) patients, respectively, while 29 (22%) patients had no evidence of coronary spasm on ACH-testing. Women were more likely to have microvascular spasm than men (68% vs. 36%, p<0.001). The prevalence of epicardial spasm did not significantly differ between female and male patients (18% vs. 31%, p=0.08). MPRI was similar in patients with microvascular spasm compared to patients without spasm (1.30 vs. 1.27, p=0.43). However, patients with epicardial spasm had significantly lower MPRI than patients without spasm (1.16 vs. 1.30, p<0.05) or those with microvascular spasm (1.16 vs. 1.27, p<0.05). Conclusion MPRI determined by stress perfusion CMR was significantly reduced in patients with epicardial spasm compared to those with microvascular spasm or normal ACH-test. This could indicate that patients with epicardial spasm have a more generalized coronary Vasomotor Disorder compared to other patients. This may be the reason for the worse outcome observed and could lead to more aggressive medical therapy and closer follow-up. Acknowledgement/Funding This work was funded by the Robert-Bosch-Stiftung, Stuttgart, Germany and the Berthold-Leibinger-Stiftung, Ditzingen, Germany.
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Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)
Clinical Research in Cardiology, 2012Co-Authors: Anastasios Athanasiadis, Heiko Mahrholdt, Gabor Borgulya, Udo Sechtem, Juan Carlos KaskiAbstract:Aims Cardiac syndrome X (CSX) is characterized by exercise-induced angina, positive exercise stress-test responses and angiographically normal coronary arteries. The condition characteristically affects more women than men and is often associated with coronary microvascular dysfunction, i.e., abnormal vasodilatory responses. Recent clinical observations suggest that increased coronary vasoconstriction may have a pathogenic role in CSX. We therefore sought to assess the prevalence of increased epicardial and microvascular coronary vasoconstriction in women with CSX. Methods and results Among 1,120 consecutive women with angina undergoing diagnostic coronary angiography 39 fulfilled criteria for CSX (mean age 63 ± 9 years) and were included in the study (27 also complained about rest angina). Five women without angina (mean age 64 ± 24 years) and normal coronary arteriograms served as controls. Patients and controls underwent intracoronary acetylcholine testing with a standardized protocol. Severe (≥75 % diameter reduction) epicardial constriction developed in 12 CSX patients (31 %) with reproduction of their angina in 10. All 12 patients showed diffuse epicardial constriction affecting mainly the distal coronary segments. Twenty-two CSX patients (56 %) experienced their usual angina without epicardial constriction of which 21 had ischemic ECG shifts. The remaining five CSX patients (13 %) had no angina or constriction in response to acetylcholine. None of the control patients had angina or constriction during ACH testing. Conclusion Increased epicardial as well as microvascular coronary constriction in response to acetylcholine are frequent findings in women with CSX. The results indicate that inappropriate coronary constriction is likely to contribute to the anginal symptoms of these patients. The ACH-test may be useful in the clinical setting to unmask this Vasomotor Disorder.
Juan Carlos Kaski - One of the best experts on this subject based on the ideXlab platform.
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Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)
Clinical Research in Cardiology, 2012Co-Authors: Anastasios Athanasiadis, Heiko Mahrholdt, Gabor Borgulya, Udo Sechtem, Juan Carlos KaskiAbstract:Aims Cardiac syndrome X (CSX) is characterized by exercise-induced angina, positive exercise stress-test responses and angiographically normal coronary arteries. The condition characteristically affects more women than men and is often associated with coronary microvascular dysfunction, i.e., abnormal vasodilatory responses. Recent clinical observations suggest that increased coronary vasoconstriction may have a pathogenic role in CSX. We therefore sought to assess the prevalence of increased epicardial and microvascular coronary vasoconstriction in women with CSX. Methods and results Among 1,120 consecutive women with angina undergoing diagnostic coronary angiography 39 fulfilled criteria for CSX (mean age 63 ± 9 years) and were included in the study (27 also complained about rest angina). Five women without angina (mean age 64 ± 24 years) and normal coronary arteriograms served as controls. Patients and controls underwent intracoronary acetylcholine testing with a standardized protocol. Severe (≥75 % diameter reduction) epicardial constriction developed in 12 CSX patients (31 %) with reproduction of their angina in 10. All 12 patients showed diffuse epicardial constriction affecting mainly the distal coronary segments. Twenty-two CSX patients (56 %) experienced their usual angina without epicardial constriction of which 21 had ischemic ECG shifts. The remaining five CSX patients (13 %) had no angina or constriction in response to acetylcholine. None of the control patients had angina or constriction during ACH testing. Conclusion Increased epicardial as well as microvascular coronary constriction in response to acetylcholine are frequent findings in women with CSX. The results indicate that inappropriate coronary constriction is likely to contribute to the anginal symptoms of these patients. The ACH-test may be useful in the clinical setting to unmask this Vasomotor Disorder.
G Pirozzolo - One of the best experts on this subject based on the ideXlab platform.
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P6004Safety assessment and results of coronary spasm provocation testing in patients with MINOCA compared to patients with stable angina and unobstructed coronary arteries
European Heart Journal, 2019Co-Authors: S Probst, A Seitz, G Pirozzolo, A Becker, T Schaeufele, R Bekeredjian, Udo SechtemAbstract:Abstract Background Approximately 10% of patients with acute myocardial infarction do not have a culprit lesion. Such patients have been labelled as MINOCA (myocardial infarction with non-obstructive coronary arteries) and several pathophysiological etiologies have been described as potential explanations. This includes spontaneous coronary dissection, tako-tsubo-syndrome and coronary spasm. The latter can be diagnosed during invasive provocative testing. The aim of this study was to assess the frequency of coronary spasm and the safety of intracoronary provocation testing using acetylcholine in MINOCA patients compared to patients with stable angina and unobstructed coronary arteries. Methods Between 2007 and 2018 180 consecutive patients with either MINOCA or stable angina and unobstructed coronary arteries were enrolled. MINOCA was defined as acute onset of chest pain with either ST-segment elevation on the ECG or significant high sensitive troponin T elevation but no relevant epicardial stenosis (<50%) according to the current ESC guidelines. All patients underwent intracoronary acetylcholine provocation testing (ACH-test) in search of coronary spasm according to a standardized protocol immediately after diagnostic coronary angiography. Apart from systematic assessment of clinical, demographic and risk factor data, data regarding complications during the ACH-test were meticulously recorded. Results Eighty patients with MINOCA and 100 consecutive patients with stable angina were recruited (52% women, mean age 62±13 years). Overall, 59% had hypertension and 20% had diabetes. Comparison of clinical, demographic and risk factor data did not reveal any statistically significant differences except for a female preponderance in the stable patients (61% vs. 40%, p=0.007). The ACH-test revealed a coronary Vasomotor Disorder in 68% of cases. In 32% of cases the ACH-test was either inconclusive or negative. Epicardial spasm was found in 31% of patients with a higher prevalence among the MINOCA patients compared to the stable angina patients (41% vs. 23%, p=0.002). Microvascular spasm was found in 37% with a higher prevalence among the stable angina patients compared to the MINOCA cohort (49% vs. 23%, p=0.002). Assessment of complications during the ACH-test revealed that 13 MINOCA patients and 15 stable angina patients had minor complications such as intermittent atrioventricular block, sinusbradycardia, paroxysmal atrial fibrillation, ventricular ectopic beats or transient hypotension. Comparison of minor complications between the two groups did not reveal statistically significant differences (16% vs. 15%, p=0.839). None of the patients experienced any irreversible complications. Conclusion Coronary spasm is a frequent cause for MINOCA. Intracoronary spasm provocation testing using acetylcholine is feasible in such patients. The complication rate during ACH-testing in MINOCA patients is low and comparable to patients with stable angina. Acknowledgement/Funding Berthold-Leibinger-Foundation, Ditzingen, Germany
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P875Myocardial perfusion reserve assessment in patients with angina pectoris and suspected coronary spasm
European Heart Journal, 2019Co-Authors: G Pirozzolo, Heiko Mahrholdt, A Seitz, A Becker, T Schaeufele, R Bekeredjian, Udo SechtemAbstract:Abstract Background Patients with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries represent a diagnostic and therapeutic challenge. Coronary Vasomotor Disorders such as coronary epicardial or microvascular spasm are frequently found among these patients. They can be diagnosed using intracoronary acetylcholine testing (ACH-test). It has been shown that patients with epicardial spasm have a worse prognosis compared to patients with microvascular spasm. The reasons for this finding are however not apparent. We speculated in this study that patients with epicardial spasm have a worse Vasomotor dysfunction compared to patients with microvascular spasm or normal ACH-test. To assess this hypothesis all patients in this study not only underwent ACH-testing but in addition also adenosine stress perfusion cardiac MRI (CMR) with calculation of the myocardial perfusion reserve index (MPRI). The latter method allows for assessment of vasodilatory function compared to the vasoconstrictor assessment using acetylcholine. Methods Between 2012 and 2016, 129 consecutive patients (mean age 64±13 years, 46% female) with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries were enrolled in this study. All patients underwent ACH-testing as well as adenosine stress perfusion CMR. According to the results of the acetylcholine test, patients were allocated to 3 groups: a) epicardial spasm (angina, ischemic ECG changes and >75% coronary diameter reduction), b) microvascular spasm (angina, ischemic ECG changes and <75% coronary diameter reduction) and c) no evidence of coronary artery spasm. CMR-derived MPRI was calculated semiquantitatively from myocardial signal intensity-over-time curves of adenosine stress and rest perfusion. Results Epicardial and microvascular spasm was found in 31 (24%) and 69 (53%) patients, respectively, while 29 (22%) patients had no evidence of coronary spasm on ACH-testing. Women were more likely to have microvascular spasm than men (68% vs. 36%, p<0.001). The prevalence of epicardial spasm did not significantly differ between female and male patients (18% vs. 31%, p=0.08). MPRI was similar in patients with microvascular spasm compared to patients without spasm (1.30 vs. 1.27, p=0.43). However, patients with epicardial spasm had significantly lower MPRI than patients without spasm (1.16 vs. 1.30, p<0.05) or those with microvascular spasm (1.16 vs. 1.27, p<0.05). Conclusion MPRI determined by stress perfusion CMR was significantly reduced in patients with epicardial spasm compared to those with microvascular spasm or normal ACH-test. This could indicate that patients with epicardial spasm have a more generalized coronary Vasomotor Disorder compared to other patients. This may be the reason for the worse outcome observed and could lead to more aggressive medical therapy and closer follow-up. Acknowledgement/Funding This work was funded by the Robert-Bosch-Stiftung, Stuttgart, Germany and the Berthold-Leibinger-Stiftung, Ditzingen, Germany.
Anastasios Athanasiadis - One of the best experts on this subject based on the ideXlab platform.
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Increased coronary vasoconstrictor response to acetylcholine in women with chest pain and normal coronary arteriograms (cardiac syndrome X)
Clinical Research in Cardiology, 2012Co-Authors: Anastasios Athanasiadis, Heiko Mahrholdt, Gabor Borgulya, Udo Sechtem, Juan Carlos KaskiAbstract:Aims Cardiac syndrome X (CSX) is characterized by exercise-induced angina, positive exercise stress-test responses and angiographically normal coronary arteries. The condition characteristically affects more women than men and is often associated with coronary microvascular dysfunction, i.e., abnormal vasodilatory responses. Recent clinical observations suggest that increased coronary vasoconstriction may have a pathogenic role in CSX. We therefore sought to assess the prevalence of increased epicardial and microvascular coronary vasoconstriction in women with CSX. Methods and results Among 1,120 consecutive women with angina undergoing diagnostic coronary angiography 39 fulfilled criteria for CSX (mean age 63 ± 9 years) and were included in the study (27 also complained about rest angina). Five women without angina (mean age 64 ± 24 years) and normal coronary arteriograms served as controls. Patients and controls underwent intracoronary acetylcholine testing with a standardized protocol. Severe (≥75 % diameter reduction) epicardial constriction developed in 12 CSX patients (31 %) with reproduction of their angina in 10. All 12 patients showed diffuse epicardial constriction affecting mainly the distal coronary segments. Twenty-two CSX patients (56 %) experienced their usual angina without epicardial constriction of which 21 had ischemic ECG shifts. The remaining five CSX patients (13 %) had no angina or constriction in response to acetylcholine. None of the control patients had angina or constriction during ACH testing. Conclusion Increased epicardial as well as microvascular coronary constriction in response to acetylcholine are frequent findings in women with CSX. The results indicate that inappropriate coronary constriction is likely to contribute to the anginal symptoms of these patients. The ACH-test may be useful in the clinical setting to unmask this Vasomotor Disorder.