Validity of Tortuosity Severity Index in Chest Pain Patients with Abnormal Exercise Test and Normal Coronary Angiography

Overview

Journal Egypt Heart J

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2018 Dec 29

PMID 30591760

Citations 5

Authors

Ayman K M Hassan

Hatem Abd-El Rahman

Safaa Gomaa Hassan

Tarek A N Ahmed

Amr Ahmed Aly Youssef

Affiliations

Soon will be listed here.

Abstract

Background: Coronary tortuosity (CT) had different definitions and scores in literature with unclear pathophysiological impact.

Objectives: To study degree of CT and it's relation to ischemic changes in patients with angina but normal coronary angiography (CA).

Methods: We conducted a prospective study at University hospitals between May 2016 and January 2017. We included 200 consecutive patients who underwent CA due to chest pain assumed to be of cardiac origin, and their CA was normal (no diameter stenosis >30%, nor myocardial bridging). Patients were prospectively divided into 2 groups based on the presence (n = 113) or absence (n = 87) of ischemic changes during stress study and compared for clinical, echocardiographic and CA characteristics. A newly proposed Tortuosity Severity Index (TSI) was developed into significant (mild/moderate CT with more than 4 curvatures in total, or severe/extreme CT with any number of curvatures) or not significant TSI (mild CT with curvatures less than or equal to 4 curvatures in total).

Results: Patients with ischemic changes had the highest rate of CT (76.5 vs 18%, p = 0.004) compared to those without. CT mostly affects the left anterior descending (LAD) coronary artery in mid and distal segments. Females, elderly, and hypertensives with left ventricular hypertrophy were strongly related to CT. Multivariate logistic regression analysis identified CT with significant TSI as the only predictor of ischemic changes in these patients (OR = 6.2, CI = 2.5-15.3, P = <0.001).

Conclusions: Coronary tortuosity is a strong predictor of anginal pain among patients with normal CA, despite positive stress study. This finding is more pronounced among elderly, hypertensive female patients.

Citing Articles

Coronary Tortuosity Index vs. Angle Measurement Method for the Quantification of the Tortuosity of Coronary Arteries in Non-Obstructive Coronary Disease.

Zebic Mihic P, Arambasic J, Mlinarevic D, Saric S, Labor M, Bosnjak I Diagnostics (Basel). 2024; 14(1).

PMID: 38201343 PMC: 10795752. DOI: 10.3390/diagnostics14010035.

Coronary Tortuosity as a New Phenotype for Ischemia without Coronary Artery Disease.

Eltahlawi M Arq Bras Cardiol. 2022; 119(6):891-892.

PMID: 36541983 DOI: 10.36660/abc.20220826.

Coronary Tortuosity as a New Phenotype for Ischemia without Coronary Artery Disease.

Estrada A, Sousa A, Mesquita C, Villacorta H Arq Bras Cardiol. 2022; 119(6):883-890.

PMID: 36169451 DOI: 10.36660/abc.20210787.

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

Jansen T, van Keeken K, Konst R, Dimitriu-Leen A, Maas A, van Royen N Front Cardiovasc Med. 2022; 8:804731.

PMID: 35097023 PMC: 8792852. DOI: 10.3389/fcvm.2021.804731.

Coronary tortuosity relation with carotid intima-media thickness, coronary artery disease risk factors, and diastolic dysfunction: is it a marker of early atherosclerosis?.

Elamragy A, Yakoub S, Abdelghany M, Ammar W Egypt Heart J. 2021; 73(1):34.

PMID: 33788058 PMC: 8012427. DOI: 10.1186/s43044-021-00157-6.

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