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Coronary reserve in Takayasu's arteritis: transesophageal echocardiographic analysis
Nilda Espinola-Zavaleta1, María Elena Soto, Lucas Bauk
1Statistical Department, Instituto Nacional de Cardiologia, Ignacio Chavez, Delegación Tlalpan, Mexico. niesza2001@hotmail.com
Insights
Transesophageal echocardiography effectively assesses coronary reserve in Takayasu's arteritis patients. This technique identified diminished coronary reserve in those with coronary lesions and dilation, aiding diagnosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Takayasu's arteritis can affect coronary arteries, often diagnosed late.
- Echocardiography shows promise for noninvasive detection of coronary stenosis.
Purpose of the Study:
- To evaluate coronary reserve in Takayasu's arteritis patients.
- Utilized contrast transesophageal echocardiography (Optison) for assessment.
Main Methods:
- Performed transesophageal echocardiograms (basal and hyperemic phases).
- Included dipyridamole challenge, myocardial perfusion studies, and coronary angiography.
- Assessed cardiovascular symptoms and patient history.
Main Results:
- Diminished coronary reserve identified in 3 patients with coronary lesions and 2 with dilation.
- Correlated with perfusion defects on SPECT imaging.
- Echocardiography revealed significant valvular regurgitation and ventricular dysfunction.
Conclusions:
- Transesophageal echocardiography is a feasible and promising tool.
- It aids in assessing coronary reserve in Takayasu's arteritis.
- Supports noninvasive evaluation of coronary involvement.
Background:
The incidence of coronary arteries lesion in Takayasu's arteritis varies from 9% to 10% and is usually discovered at autopsy. Recent studies have demonstrated the value of echocardiography in noninvasive detection of significant coronary stenosis.
Aim:
The aim of our study was to evaluate coronary reserve in 15 patients with Takayasu's arteritis using contrast transesophageal echocardiography (Optison).
Methods:
Transesophageal echocardiogram under basal conditions and in the hyperemic phase with dipyridamole challenge, myocardial perfusion studies and coronary angiography were performed on all patients. Seventy-three percent of them had histories of systemic hypertension, and the most frequent cardiovascular symptoms were shortness of breath (80%), headache (46%), angina (40%), and dizziness (33%).
Results:
The transthoracic echocardiogram showed left ventricular systolic dysfunction in 6% and diastolic dysfunction in 53%. Aortic regurgitation was found in 67% of the patients, and 60% had mitral and/or tricuspid regurgitation. Coronary reserve was diminished in 3 patients with significant coronary lesions and in 2 patients with coronary dilation (33%). In the 3 patients with obstructive lesions and diminished coronary reserve, reversible perfusion defects were found with thallium-201 single-photon emission computed tomography. One patient with coronary dilation had normal perfusion, while the other demonstrated reversible and irreversible perfusion defects. One patient without coronary lesions and with normal coronary reserve had an irreversible fibrotic changes and the other reversible defects due to abnormal microcirculation.
Conclusions:
Transesophageal echocardiography is a feasible and promising technique for assessing coronary reserve in patients with Takayasu's arteritis.
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