Related Experiment Video
Updated: Aug 4, 2025
Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
Published on: April 13, 2015
Prognostic implications of left ventricular systolic dysfunction in patients with spontaneous coronary artery
Pablo Díez-Villanueva1, Marcos García-Guimarães2, Ricardo Sanz-Ruiz3
1Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid, Spain.
Insights
Spontaneous coronary artery dissection (SCAD) patients with reduced left ventricular ejection fraction (LVEF) present differently and face higher in-hospital events. Despite specific discharge medications, these SCAD patients experience increased long-term mortality and heart failure readmissions.
Area of Science:
- Cardiology
- Vascular Biology
- Acute Coronary Syndromes
Background:
- Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS).
- Limited data exists on SCAD patients presenting with reduced left ventricular ejection fraction (LVEF).
Purpose of the Study:
- To investigate the clinical features, angiographic findings, management, and outcomes of SCAD patients with reduced LVEF compared to those with preserved LVEF.
Main Methods:
- A prospective, multicenter registry of 389 SCAD patients was analyzed.
- Echocardiography assessed LVEF in 348 patients, comparing outcomes between those with LVEF <50% (n=53) and LVEF ≥50% (n=295).
Main Results:
- Reduced LVEF patients were younger women, presenting more frequently with ST-segment elevation myocardial infarction (STEMI), particularly anterior STEMI.
- In-hospital events, including death, cardiogenic shock, and stroke, were higher in the reduced LVEF group.
- Despite similar initial revascularization rates, reduced LVEF patients had significantly higher long-term mortality and heart failure readmissions.
Conclusions:
- SCAD patients with reduced LVEF exhibit distinct clinical and angiographic profiles.
- These patients face worse outcomes, including higher mortality and heart failure readmissions, necessitating tailored management strategies.
Aims:
Spontaneous coronary artery dissection (SCAD) is a relatively infrequent cause of acute coronary syndrome. Clinical features, angiographic findings, management, and outcomes of SCAD patients who present reduced left ventricular ejection fraction (LVEF) remain unknown.
Methods And Results:
The Spanish multicentre prospective SCAD registry (NCT03607981), included 389 consecutive patients with SCAD. In 348 of these patients, LVEF could be assessed by echocardiography during the index admission. Characteristics and outcomes of patients with preserved LVEF (LVEF ≥50%, n = 295, 85%) were compared with those with reduced LVEF (LVEF <50%, n = 53, 15%). Mean age was 54 years and 90% of patients in both groups were women. The most frequent clinical presentation in patients with reduced LVEF was ST-segment elevation myocardial infarction (STEMI) (62% vs. 36%, P < 0.001), especially anterior STEMI. Proximal coronary segment and multi-segment involvement were also significantly more frequent in these patients. No differences were found on initial revascularization between groups. Patients with reduced LVEF significantly received more often neurohormonal antagonist therapy, and less frequently aspirin. In-hospital events were more frequent in these patients (13% vs. 5%, P = 0.01), with higher rates of death, cardiogenic shock, ventricular arrhythmia, and stroke. During a median follow-up of 28 months, the occurrence of a combined adverse event did not statistically differ between the two groups (19% vs. 12%, P = 0.13). However, patients with reduced LVEF had higher mortality (9% vs. 0.7%, P < 0.001) and readmission rates for heart failure (HF) (4% vs. 0.3%, P = 0.01).
Conclusion:
Patients with SCAD and reduced LVEF show differences in clinical characteristics and angiographic findings compared with SCAD patients with preserved LVEF. Although these patients receive specific medications at discharge, they had higher mortality and readmission rates for HF during follow-up.
More Related Videos
08:19Transthoracic Echocardiography to Assess Post-Resuscitation Left Ventricular Dysfunction After Acute Myocardial Infarction and Cardiac Arrest in Pigs
Published on: July 12, 2022
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:22Mitral Stenosis I: Introduction
01:25Aortic Regurgitation III: Medical Management