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Spectrum of coronary artery disease in idiopathic hypertrophic subaortic stenosis
Insights
Idiopathic hypertrophic subaortic stenosis (IHSS) patients over 45 show a significant incidence of coronary arterial involvement. This involvement, including atherosclerosis and anomalies, did not alter clinical features but affected electrocardiogram findings.
Area of Science:
- Cardiology
- Cardiovascular Diseases
- Internal Medicine
Background:
- Idiopathic hypertrophic subaortic stenosis (IHSS) is a condition affecting the heart's outflow tract.
- Coronary arterial involvement can occur in patients with IHSS, but its spectrum and impact require further elucidation.
Purpose of the Study:
- To describe the spectrum of coronary arterial involvement in patients with IHSS.
- To investigate the clinical, hemodynamic, and electrocardiographic features associated with coronary arterial involvement in IHSS patients.
Main Methods:
- Retrospective analysis of 42 patients with hemodynamically proven IHSS.
- Evaluation of coronary angiography findings, clinical presentation, and electrocardiograms (ECGs).
Main Results:
- Nine out of 42 IHSS patients (21%) had significant coronary arterial involvement.
- Six patients had atheromatous disease, and three had coronary arterial anomalies.
- No significant differences in hemodynamic or clinical features were observed between patients with and without coronary involvement.
- Classic electrocardiographic features of myocardial infarction were absent in patients with coronary involvement but present in 8/33 patients with normal coronary arteries.
- A significant incidence of coronary arterial involvement was noted in IHSS patients over 45 years of age.
Conclusions:
- Coronary arterial involvement is a notable finding in IHSS, particularly in older patients.
- Coronary artery disease and anomalies in IHSS do not typically alter the clinical presentation or hemodynamic status.
- Electrocardiographic patterns suggestive of myocardial infarction are less common in IHSS patients with concurrent coronary arterial involvement.
Abstract:
The spectrum of coronary arterial involvement is described in 42 patients with hemodynamically proved idiopathic hypertrophic subaortic stenosis. Of nine patients with significant coronary arterial involvement, six had atheromatous disease and three had coronary arterial anomalies. The hemodynamic and clinical features of patients with coronary arterial involvement did not differ significantly from those of patients with normal coronary arteries. Neither the severity nor the character of the chest pain distinguished those patients with coronary disease. The diagnostic electrocardiographic features of myocardial infarction classically seen in patients with idiopathic hypertrophic subaortic stenosis were not present in the 9 patients with coronary arterial involvement but were found in 8 of the 33 patients with normal coronary arteries. The data demonstrate a significant incidence of coronary arterial involvement in patients with idiopathic hypertrophic subaortic stenosis after age 45 years.