Publications by authors named "Sechtem U"
Article Synopsis
- Coronary functional disorders (CFD) significantly contribute to angina in patients with non-obstructed coronary arteries (ANOCA), with different endotypes identified, such as microvascular spasm and coronary microvascular dysfunction (CMD).
- A study involving 89 ANOCA patients using comprehensive coronary functional testing (CFT) found that 91% had at least one disorder, with microvascular spasm being the most common (61%).
- The results highlighted that isolated CMD is rare and emphasized the necessity of spasm testing for diagnosing and characterizing CFD in ANOCA patients.
Article Synopsis
- * The research involved 372 patients with angina but non-obstructive coronary arteries, comparing results from those who received RASP vs. those who did not during ACh provocation testing.
- * Findings indicated that RASP did not significantly change the frequency or type of coronary vasomotor responses when tested with ACh, meaning it can be safely used in patients undergoing spasm testing.
Myocardial ischemia is a complex condition which may result from epicardial and/or microvascular causes involving functional and structural mechanisms. These mechanisms may overlap in a given patient illustrating the difficulties for appropriate management. Assessment of myocardial ischemia can be performed using noninvasive and invasive tools.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the genetic factors contributing to coronary artery spasm (CAS) in European patients with angina and unobstructed coronary arteries, particularly focusing on variants from 208 cardiovascular-related genes.
- Although no findings met the genome-wide significance threshold, suggestive genetic associations were found for focal and diffuse epicardial CAS, particularly relating to genes CDH13 and HDAC9, EDN1 respectively.
- The research suggests that EDN1 may be a potential genetic risk factor for diffuse epicardial CAS, with elevated plasma endothelin-1 levels identified as a possible cardiac marker.
Background: Electrocardiograms (ECGs) recorded with wearable devices and additional smartphone apps play an increasing role in cardiology.
Case Summaries: We present two cases in which it was possible to record an ECG during cardiac-related symptoms using the patients' smartphones. Previous standard resting and 24-hour ECGs had revealed no pathologies.
Background: Current diagnostic criteria for coronary spasm are based on patient's symptoms, ECG shifts and epicardial vasoconstriction during acetylcholine (ACh) spasm testing.
Aims: To assess the feasibility and diagnostic value of coronary blood flow (CBF) and resistance (CR) assessment as objective parameters during ACh testing.
Methods: Eighty-nine patients who underwent intracoronary reactivity testing including ACh testing with synchronous Doppler wire-based measurements of CBF and CR were included.
Article Synopsis
- Coronary artery spasm (CAS) is recognized as a cause of angina in patients who have non-obstructive coronary artery disease (ANOCA), but varying diagnostic criteria complicate accurate identification.
- A systematic review analyzed data from 25 studies, revealing that epicardial spasm is found in 43% (higher in Asians) while microvascular spasm is seen in 25%, with men more likely to have epicardial and women microvascular spasms.
- CAS is common among ANOCA patients, with a significant occurrence of recurrent angina, highlighting the need for standardized testing protocols and assessments of CAS in both men and women.
Article Synopsis
- Angina and dyspnea in patients with normal coronary arteries present a diagnostic challenge, with many possibly suffering from coronary microvascular dysfunction (CMD) rather than traditional coronary artery disease.
- Positron emission tomography (PET) is used to measure myocardial blood flow (MBF) and reserve (MFR), which helps noninvasively detect CMD, leading to better understanding of patients' symptoms.
- A consensus document is in development to standardize the diagnosis and reporting for CMD to improve treatment decisions and patient outcomes, involving experts from around the world.
Background: Angina pectoris in the absence of relevant epicardial stenoses is frequently caused by coronary spasm. This mechanism of angina is common yet underdiagnosed in daily clinical practice. The pathophysiology of coronary spasm is complex, multifactorial, and not completely understood.
View Article and Find Full Text PDFUnlabelled: BackgroudThe aim of this study was to assess the prognostic association of plasma levels of -terminal prohormone of brain natriuretic peptide (NT-proBNP) with clinical outcomes of patients with microvascular angina (MVA).
Methods: In this international prospective cohort study of MVA by the Coronary Vasomotor Disorders International Study (COVADIS) group, we examined the association between plasma NT-proBNP levels and the incidence of major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and hospitalization due to heart failure or unstable angina.
Results: We examined a total of 226 MVA patients (M/F 66/160, 61.
Background: Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.
Objective: We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation.
Methods: The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.
Coronary artery disease remains the leading cause of death in developed countries. This CME article addresses and comments on important aspects from the current guidelines for the diagnosis and management of chronic coronary syndrome of the European Society of Cardiology (ESC) and the current guidelines for the evaluation and diagnosis of chest pain of the American Heart Association (AHA)/the American College of Cardiology (ACC).
View Article and Find Full Text PDFMultivessel coronary disease is a frequent finding in patients with STEMI. However, choosing the optimal treatment strategy for these patients can be challenging. The benefit of complete versus culprit-vessel-only revascularization demonstrated by several studies led to a change in the current 2018 ESC/EACTS revascularization guidelines recommending treatment of nonculprit lesions before hospital discharge.
View Article and Find Full Text PDFNon-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
J Cardiovasc Comput Tomogr
July 2022
Background: Coronary spasm has been suggested to be the underlying mechanism of chest pain in patients with myocarditis and unobstructed coronary arteries. Here we sought to investigate a potential association between virus type and coronary spasm endotype in patients with biopsy-proven viral myocarditis.
Methods: A total of 618 consecutive patients with unobstructed coronary arteries who underwent endomyocardial biopsy between 2008 and 2018 were screened.
Importance: In today's era of precision medicine a renaissance of functional coronary disease including coronary artery spasm (CAS) can be observed. This development is fueled by novel diagnostic methods as well as first evidence from randomized trials regarding targeted treatment approaches. The present review provides a contemporary update on advances in the pathophysiological understanding, diagnosis, treatment and prognosis of CAS.
View Article and Find Full Text PDFWe here present the case of a 55-year old woman who presented with recurrent angina at rest followed by presyncopal attacks and nausea to our clinic. Her only cardiovascular risk factor was arterial hypertension. High-sensitive troponin T was 3 pg/ml ( < 14 pg/ml) and the 12-lead resting ECG was unremarkable.
View Article and Find Full Text PDFObjectives: The present study aimed to assess the feasibility and clinical value of acetylcholine (ACh) rechallenge for the detection of coexisting epicardial and microvascular spasm and to determine the efficacy of nitroglycerin in these spasm endotypes.
Background: The coexistence of epicardial and microvascular spasm is difficult to identify; thus, its frequency is unknown. Nitroglycerin treatment is equally recommended for both epicardial and microvascular coronary spasm despite contradictory data.
Coronary functional abnormalities are frequent causes of angina pectoris, particularly in patients with unobstructed coronary arteries. There is a spectrum of endotypes of functional coronary abnormalities with different mechanisms of pathology including enhanced vasoconstriction (i.e.
View Article and Find Full Text PDFNon-invasive imaging in coronary syndromes: recommendations of the European Association of Cardiovascular Imaging and the American Society of Echocardiography, in collaboration with the American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
Eur Heart J Cardiovasc Imaging
January 2022
Study Objective: The Coronary Vasomotor Disorders International Study Group (COVADIS) invited leading experts to address strategies to enhance our clinical understanding of INOCA with an emphasis on the management of coronary vasomotor disorders.
Design: Under-recognition of coronary vasomotor disorders, distinguishing different presentations of angina due to vasospasm and/or abnormal microvascular vasodilatation, developing invasive/non-invasive testing and treatment protocols, integrating diagnostic protocols into cardiologists' workflow and trials to inform guideline development were identified as key knowledge gaps and will be briefly addressed in this Viewpoint article.
Setting: Virtual international meeting.
Background: Functional coronary disorders such as coronary spasm and microvascular dysfunction (including microvascular spasm and impaired microvascular dilatation) are frequent findings among patients with angina and non-obstructed coronary arteries (ANOCA). In this study, we investigated a potential association of coronary spasm and myocardial perfusion abnormalities as well as predictors of such functional coronary disorders in ANOCA patients using a multimodality diagnostic strategy including adenosine stress CMR and intracoronary acetylcholine testing.
Methods: We enrolled 129 patients with ANOCA who underwent acetylcholine testing and adenosine stress perfusion CMR.