Sex-Specific Factors in Microvascular Angina

Sedlak, Tara; Izadnegahdar, Mona; Humphries, Karin H.; Merz, C. Noel Bairey

doi:10.1016/j.cjca.2013.08.013

Cited by 15 publications

(8 citation statements)

References 61 publications

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“…There were no significative statistical differences regarding age or risk factors except for hypercholesterolemia (present in all patients with suspected microvascular angina). There was a significant difference in gender among the groups: females were preponderant in microvascular angina group, as expected considering the prevalence of this disease in the general population . Table shows the evaluated standard echo parameters, heart rate, and systolic and diastolic pressure at rest and at dipyridamole peak dose.…”

Section: Resultsmentioning

confidence: 54%

“…There was a significant difference in gender among the groups: females were preponderant in microvascular angina group, as expected considering the prevalence of this disease in the general population. 15 Table 2 shows the evaluated standard echo parameters, heart rate, and systolic and diastolic pressure at rest and at dipyridamole peak dose. No significant difference was found in LV volumes or EF.…”

Section: Generalcharacteristicandstandardecho Parameters In the Stumentioning

confidence: 99%

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Layer‐specific strain in dipyridamole stress echo: A new tool for the diagnosis of microvascular angina

et al. 2018

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Background Dipyridamole stress echocardiography (DSE) represents a fundamental test in patients with suspected coronary artery disease (CAD). The diagnosis of microvascular disease is still challenging. We aimed to determine the diagnostic value of left ventricular (LV) layer‐specific longitudinal (LS) and circumferential strain (CS) by Speckle Tracking in detecting CAD during DSE and to study if they can help in discriminate between a negative echo and a suspected microvascular angina. Methods and results We enrolled 66 patients with known or suspected CAD. All underwent standard DSE. We identified 3 groups according to the result of DSE (36 negative DSE, 19 positive DSE, 11 indicatives for microvascular disease). Wall motion score index, global LV LS and CS (global longitudinal strain [GLS] and global circumferential strain [GCS]), and layer‐specific LV LS and CS were measured at rest and peak stress. The Delta between rest and peak stress values was calculated. GLS increased after injection in negative DSE and microvascular disease while reducing in positive DSE. Endocardial GCS and transmural GCS values were stable in microvascular disease while increasing significantly in negative DSE, helping in the diagnosis. The specific analysis of endocardial LS showed the most powerful difference between healthy and macrovascular CAD patients, both for LS and CS. Conclusions Global circumferential strain can be a new valuable added tool in the echocardiographic diagnosis of microvascular disease. Endocardial GLS is the best indicator of an altered wall deformation in the presence of macrovascular ischemia.

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Section: Resultsmentioning

confidence: 54%

Section: Generalcharacteristicandstandardecho Parameters In the Stumentioning

confidence: 99%

Layer‐specific strain in dipyridamole stress echo: A new tool for the diagnosis of microvascular angina

et al. 2018

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“…This condition, previously known as cardiac syndrome X, is named microvascular angina, which often pertains to women with symptoms of chronic stable angina, normal or near-normal coronary arteries, and evidence of ischaemia during stress testing or during acetylcholine testing 13,14 . Increasing attention has been focused on the recognition of this condition, and microvascular angina might occur in up to 40% of patients with angina, depending on the studies [15][16][17] . This high percentage, however, includes patients with the symptoms of chronic stable angina with suspected ischaemia, but without a clear demonstration of it.…”

Section: Pathophysiologymentioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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Chronic stable angina pectoris is the most prevalent symptomatic manifestation of ischaemic heart disease, and its management is a priority (BOX 1). Current clinical guidelines recommend antianginal therapy to control symptoms, before considering coronary artery revasculariza tion [1][2][3][4] . However, revascularization by either percutaneous coronary angioplasty or CABG surgery is indicated in patients who have significant artery steno sis (50% left main narrowing or proximal three-vessel disease) to reduce myocardial ischaemia and its adverse clinical manifestation. Antianginal agents are approved by documenting that they improve total exercise duration, together with a reduction in daily frequency of chronic stable angina compared with placebo and/or equivalence to an active comparator. Cardiovascular outcomes, although highly advocated, are not a pre requisite for regulatory approval. None of the antianginal drugs has been proved to reduce cardiovascular mortality or the rate of myocardial infarction. When patients are optimally treated, mortality for chronic stable angina is low, which might explain why all trials designed to improve prognosis have been negative. Guidelines recom mend a first-choice and a second-choice approach, based more on tradition and expert opinion, rather than evidence. This categorical approach has been questioned in the past couple of years 5-8 . Newer antianginal drugs, which are classified as second choice, have more evidence-based clinical data that are more contemporary to support their use than is available for the traditional first-choice drugs. Equally, the often-needed combin ation of double or triple therapy is based on expert opinion and not related to the underlying pathophysio logy. What constitutes optimal antianginal treatment, therefore, varies considerably between countries, and the majority of doctors treat their patients according to their own preconceptions.A group of experts with experience and interest in chronic stable angina met at the University of Ferrara, Italy, to discuss an individualized approach to medical treatment of chronic stable angina, on the basis E X P E RT C O N S E N S U S D O C U M E N TA 'diamond' approach to personalized treatment of angina Abstract | In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for tr...

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“…In a study reported by Sedlak et al, 10.2% of patients with MINOCA were females, compared to 6.8% males. 11 A prospective study conducted by Reynolds et al investigated the mechanisms involved in the occurrence of MINOCA in 42 female patients. 12 After one week from the acute event, the patients underwent CMR imaging, which revealed that 39% had late gadolinium enhancement of CMR -the most common sign of myocardial ischemiaand 53% presented myocardial edema upon T2 sequence examination, which appears as a hyperintensity in the affected area.…”

Section: The Role Of Coronary Computed Tomography Angiography In Patimentioning

confidence: 99%

The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography

Beganu¹,

Rodean²,

Bordi³

et al. 2017

Journal of Interdisciplinary Medicine

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Usually, the diagnosis of myocardial infarction based on patient symptoms, electrocardiogram (ECG) changes, and cardiac enzymes, is not a challenge for cardiologists. The correlation between coronary anatomy and the ECG territories that present ischemic changes can help the clinician to estimate which coronary artery presents lesions upon performing a coronary angiogram. In certain situations, the diagnosis of myocardial infarction can be difficult due to the lack of correlations between the clinical and paraclinical examinations and the coronary angiogram. In some cases, patients with chest pain and ST-segment elevation on the ECG tracing present with a normal coronary angiography. In other cases, patients without important changes on the ECG can present critical lesions or even occlusions upon angiographic examination. The aim of this article is to highlight the role of noninvasive coronary magnetic resonance and multi-slice computed tomography in patients with ST-segment elevation myocardial infarction and normal coronary angiography.

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Sex-Specific Factors in Microvascular Angina

Cited by 15 publications

References 61 publications

Layer‐specific strain in dipyridamole stress echo: A new tool for the diagnosis of microvascular angina

Layer‐specific strain in dipyridamole stress echo: A new tool for the diagnosis of microvascular angina

A 'diamond' approach to personalized treatment of angina

The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography

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