Relation Between Coronary Tortuosity and Vasomotor Dysfunction in Patients Without Obstructed Coronaries?

Area of Science:

• Cardiology
• Vascular Biology

Background:

• A significant portion of patients with angina and no obstructive coronary artery disease (ANOCA) exhibit underlying coronary vasomotor dysfunction (CVDys).
• Coronary function tests (CFT) diagnose CVDys, and coronary tortuosity is a frequent angiographic observation during these tests.
• Existing data lack information on the link between CVDys and coronary tortuosity.

Purpose of the Study:

• To investigate the association between coronary vasomotor dysfunction (CVDys) and coronary tortuosity in patients diagnosed with angina and no obstructive coronary artery disease (ANOCA).

Main Methods:

• Consecutive ANOCA patients undergoing clinically indicated CFT (February 2019-November 2020) were analyzed.
• CFT involved acetylcholine spasm testing for epicardial/microvascular spasm and adenosine testing for microvascular dysfunction (MVD).
• MVD was defined by an index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) < 2.0. Coronary tortuosity was graded (none, mild, moderate, severe) in the LAD artery.

Main Results:

• 228 ANOCA patients (86% female, mean age 56±9 years) were included.
• Coronary artery spasm occurred in 81% and MVD in 45% (15% abnormal CFR, 30% abnormal IMR).
• No significant differences in CVDys prevalence were observed across tortuosity groups (no, mild, moderate).

Conclusions:

• Coronary vasomotor dysfunction (CVDys) was not found to be associated with coronary tortuosity in this ANOCA patient cohort.
• Further experimental and clinical research is warranted to explore the complex interactions involving coronary tortuosity, wall shear stress, endothelial dysfunction, and coronary flow.