Abstract
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Objectives: Coronary tortuosity (CorT) is commonly detected in angiographic studies. The association of this anatomical feature with myocardial ischemia is not universally accepted. Our objective is to evaluate the relationship between CorT and ischemia detected by myocardial perfusion scintigraphy. We evaluated the angiographic findings in patients with chest pain and no obstruction greater than 30% in major coronary epicardial arteries and compared then with myocardial perfusion scintigraphy findings per patient and per vessel. Patients and Methods: The study included 33 patients (27 females), aged 40-58 years (mean, 58.6 +/- 9 [SD] with chest pain and non-obstructive coronary anatomy. By reviewing the angiographic film, some variables including stenosis (less than 30% of vessel diameter) and tortuosity were evaluated. CorT is defined as a fixed ≥ 3 bends during both systole and diastole, with bend tortuosity angle less than 90°. All patients had been undergone on myocardial perfusion imaging (MPI). Clinical and demographics findings were evaluated in order to relate them to ischemia findings.
Results: Ischemia was detected in 17 patients and CorT in 9 patients, 11 vessels with tortuosity: 5 cases in LAD, 4 cases LCX and 2 cases in RCA. By bivariate regression, ischemia on scintigraphy correlated only with age in years (p = 0.05) and the presence of dyspnea (p = 0.12). The confirmed finding in the multivariate regression analysis at different levels of pre-independence of ischemia was elderly (p = 0.035) and dyspnea (p = 0.041). The association between CorT and myocardial ischemia was not found (p = 0.29) when analyzed per patient. However, in the analysis per vessel, there was a significant association between ischemia and tortuosity in non-LAD vessels: LCX (p = 0.023) and RCA (p = 0.006). This association was not found in LAD (p = 0.15). Angiographic findings associated with ischemia in patients with CorT were the number of consecutive angles less than 90 degrees in systole in LCX territory (p = 0.021) and the value of the smallest angle in the diastole (p = 0.042) and the number of consecutive angles less than 90 degrees in the diastole (p = 0.046) in RCA territory.
Conclusions: We found an association in non-LAD coronary vessels tortuosity and ischemia in myocardial perfusion scintigraphy. Some angiographic findings were associated with ischemia in patients with CorT such as the largest number of angles less than 90 degrees, the value of the smallest angle in the diastole and the number of consecutive angles less than 90 degrees in the diastole according to coronary territories. This observation needs to be expanded because of the relatively small sample, however, it is important to note that the presence of ischemia in the absence of obstructive epicardial disease is growing importance in clinical practice. This is the first study in the literature that relates specific abnormalities in coronary geometry to the origin of myocardial ischemia.