Different vasoreactivity of arterial bypass grafts versus native coronary arteries in response to acetylcholine

Pirozzolo, Giancarlo; Seitz, Andreas; Pereyra, Valeria Martínez; Athanasiadis, Anastasios; Albert, Marc; Franke, Ulrich; Bekeredjian, Raffi; Sechtem, Udo; Ong, Peter

doi:10.1007/s00392-020-01694-x

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Coronary spasm in patients with previous bypass operation but no relevant stenosis is not an infrequent finding. In a recent study by Pirozzolo et al it was shown that 81% of such patients had epicardial or microvascular spasm during acetylcholine testing via the LITA graft [4]. In contrast, spasm of the bypass graft could not be documented.…”

Section: Manuscriptmentioning

confidence: 97%

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Structural or Functional Coronary Artery Disease? Acetylcholine Testing Reveals Epicardial Spasm After Multiple Myocardial Revascularizations

et al. 2021

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Section: Manuscriptmentioning

confidence: 97%

“…In a recent study by Pirozzolo et al., it was shown that 81% of such patients had epicardial or microvascular spasm during acetylcholine testing via the LITA graft. 4 In contrast, spasm of the bypass graft could not be documented. However, this type of spasm has been described in the intra- or perioperative phase.…”

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confidence: 96%

Structural or Functional Coronary Artery Disease? Acetylcholine Testing Reveals Epicardial Spasm After Multiple Myocardial Revascularizations

et al. 2021

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“…Coronary microvascular dysfunction, which has been related to cardiovascular risk factors and advanced atherosclerosis (frequently observed in prior CABG patients), can cause myocardial ischemia during stress testing in the absence of obstructive epicardial coronary disease. One should bear in mind that myocardial perfusion imaging (MPI) values in patients with prior cardiac history may be globally reduced solely due to diffuse CAD and coronary microvascular disease, which negatively impacts the specificity to detect significant graft failure and/or progression of native epicardial lesions [ 16 , 49 – 52 ]. Furthermore, chronic coronary syndrome guidelines do not list recommendations on the preferred stress test for patients with recurrent angina ≥ 1 year after initial revascularization, thus application is based on patient characteristics, clinical likelihood, local expertise, availability, and individual clinician preference.…”

Section: Diagnostic Evaluation and Non-invasive Imaging In Patients W...mentioning

confidence: 99%

Diagnostic and Management Strategies in Patients with Late Recurrent Angina after Coronary Artery Bypass Grafting

et al. 2022

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Purpose of Review This review will outline the current evidence on the anatomical, functional, and physiological tools that may be applied in the evaluation of patients with late recurrent angina after coronary artery bypass grafting (CABG). Furthermore, we discuss management strategies and propose an algorithm to guide decision-making for this complex patient population. Recent Findings Patients with prior CABG often present with late recurrent angina as a result of bypass graft failure and progression of native coronary artery disease (CAD). These patients are generally older, have a higher prevalence of comorbidities, and more complex atherosclerotic lesion morphology compared to CABG-naïve patients. In addition, guideline recommendations are based on studies in which post-CABG patients have been largely excluded. Summary Several invasive and non-invasive diagnostic tools are currently available to assess graft patency, the hemodynamic significance of native CAD progression, left ventricular function, and myocardial viability. Such tools, in particular the latest generation coronary computed tomography angiography, are part of a systematic diagnostic work-up to guide optimal repeat revascularization strategy in patients presenting with late recurrent angina after CABG.

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“…Studies have shown that coronary functional abnormalities can be found in ~60–70% of patients who have had previous successful myocardial revascularisation procedures and have ongoing/recurrent symptoms. [ 41 , 42 ]…”

Section: Epidemiology Of Coronary Functional Abnormalitiesmentioning

confidence: 99%

Definitions and Epidemiology of Coronary Functional Abnormalities

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Coronary functional abnormalities are frequent causes of angina pectoris, particularly in patients with unobstructed coronary arteries. There is a spectrum of endotypes of functional coronary abnormalities with different mechanisms of pathology including enhanced vasoconstriction (i.e. coronary artery spasm) or impaired vasodilatation, such as impaired coronary flow reserve or increased microvascular resistance. These vasomotor abnormalities can affect various compartments of the coronary circulation such as the epicardial conduit arteries and/or the coronary microcirculation. Unequivocal categorisation and nomenclature of the broad spectrum of disease endotypes is crucial both in clinical practice as well as in clinical trials. This article describes the definitions of coronary functional abnormalities with currently accepted cut-off values, as well as diagnostic methods to identify and distinguish endotypes. The authors also provide a summary of contemporary data on the prevalence of the different endotypes of coronary functional abnormalities and their coexistence.

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Different vasoreactivity of arterial bypass grafts versus native coronary arteries in response to acetylcholine

Cited by 4 publications

References 26 publications

Structural or Functional Coronary Artery Disease? Acetylcholine Testing Reveals Epicardial Spasm After Multiple Myocardial Revascularizations

Structural or Functional Coronary Artery Disease? Acetylcholine Testing Reveals Epicardial Spasm After Multiple Myocardial Revascularizations

Diagnostic and Management Strategies in Patients with Late Recurrent Angina after Coronary Artery Bypass Grafting

Definitions and Epidemiology of Coronary Functional Abnormalities

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